Keywords
simplah oil
urea
cost-effectiveness analysis
ACER
ICER
How to Cite
Abstract
Xerosis cutis is a common chronic dry skin condition, particularly among the elderly, and can impair quality of life. Topical therapy with moisturizers such as urea cream has been the standard, but its availability and cost are often constraints. Simplah oil, a traditional fermented Acehnese coconut oil rich in lauric, myristic, and palmitic acids, has the potential to be an effective and affordable alternative. This study aimed to analyze the clinical effectiveness and cost-effectiveness of simplah oil ointment compared to urea cream in patients with xerosis cutis. This study used a randomized parallel clinical trial design (block randomization) conducted at the Dermatology and Venereology Outpatient Clinic of dr. Zainoel Abidin General Hospital, Banda Aceh, from June to September 2025. A total of 26 subjects aged 18–65 years were recruited by consecutive sampling and divided into two groups: the intervention group received 10% simplah oil ointment and the control group received 20% urea cream, each applied twice daily for 8 weeks; 24 subjects (12 per group) completed the study and were analyzed. Parameters measured at weeks 0 and 8 included TEWL (Transepidermal Water Loss), skin hydration (Corneometer), ODSS (Objective Dry Skin Score), and DLQI (Dermatology Life Quality Index). Within-group differences were analyzed using the paired sample t-test, and between-group differences using the independent sample t-test on delta values. Pharmacoeconomic analysis from the hospital perspective used ACER (Average Cost-Effectiveness Ratio) and ICER (Incremental Cost-Effectiveness Ratio) based on the direct medical cost of the products, with effectiveness defined as the percentage of subjects achieving a DLQI reduction of ≥5 points. Both groups showed significant improvement in all parameters after 8 weeks (p<0.05). Improvement in skin hydration was significantly greater in the simplah oil group (mean difference 11.15 AU; p=0.009), whereas reductions in TEWL (p=0.314), ODSS (p=0.064), and DLQI (p=0.092) did not differ significantly between groups. Effectiveness was 75% for simplah oil and 83.33% for urea cream, at direct medical costs of IDR 50,000 and IDR 90,000 per subject, respectively. ACER was lower for simplah oil (IDR 666.67/%) than for urea cream (IDR 1,080.00/%). The ICER was IDR 4,800.00 for each additional 1% effectiveness of urea cream compared to simplah oil. Simplah oil ointment may be considered an alternative because it did not differ significantly from urea cream in TEWL, ODSS, and DLQI, with greater improvement in skin hydration and a lower cost per unit of effectiveness; clinical equivalence cannot be concluded.
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