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Background Rational health care decision-making based on outcomes and economic evidence is essential to provide the best possible care for individual patients with atopic dermatitis (AD). Objectives To describe treatment outcomes and to evaluate resource utilization and associated cost of maintenance use of tacrolimus ointment (MU) vs. standard use of tacrolimus ointment (SU) in adults with AD. Methods A pan-European, phase III multicentre randomized clinical trial was conducted. Patients with mild to severe AD were randomized to tacrolimus 0·1% ointment (MU) or vehicle (SU) twice per week for 12 months. Disease exacerbations were treated by using open-label tacrolimus 0·1% ointment twice daily. Resource utilization data were collected prospectively alongside the clinical trial. Costs of pooled resource data were determined using German unit cost data. Direct and indirect costs were considered from third party payer, patient and societal perspectives. Results All patients with moderate and severe AD were included in a subanalysis, 75 patients in the MU arm (57% moderately affected) and 59 patients in the SU arm (59% moderately affected). In patients with moderate AD, the number of disease exacerbations in the MU arm was 2·4 vs. 5·5 in the SU arm ( P < 0·001); in patients with severe AD corresponding figures were 2·3 vs. 7·4 ( P < 0·001), respectively. Mean ± SD total annual cost per patient was €1525 ± 1081 (MU) vs. €1729 ± 1209 (SU) in patients with moderate AD and €2045 ± 2013 (MU) vs. €2904 ± 1510 (SU) in patients with severe AD. Conclusions Maintenance treatment with 0·1% tacrolimus ointment is more effective and leads to cost savings and improved health-related quality of life in comparison with standard use of 0·1% tacrolimus ointment, especially in patients with severe AD. [ABSTRACT FROM AUTHOR]