Multinational pharmacoeconomic analysis of topical and oral therapies for onychomycosis

BACKGROUND: Systemic antifungal agents are effective in the treatment of onychomycosis; however, they are associated with high acquisition costs and adverse effects, sometimes of a not insignificant nature. New topical therapies are less expensive, have superior tolerability and better efficacy rates compared to the old topical antifungal agents. PURPOSE: Pharmacoeconomic analysis of topical lacquers and oral agents for the treatment of mild to moderate onychomycosis in Canada, France, Germany, Italy, Spain and the UK. METHODS: Two topical lacquers, amorolfine (AMO) and ciclopirox (CIC), and the oral agents griseofulvin (GRI), itraconazole (ITR), and terbinafine (TER) were examined using a predictive (decision tree) model. Expert panels determined clinical practice patterns, reimbursement practices and standard costs for health care resource items in each country. Metaanalysis was used to determine clinical success rates. Data were analyzed over a 5-year horizon, with a 5% discounting rate. The sensitivity of the model was examined using rank order stability analysis (ROSA). The cost per regimen, total expected costs of therapy, and cost per symptom-free day (SFD) were calculated. RESULTS: CIC as first-line therapy had the lowest expected cost and lowest cost per SFD followed by AMO and then by TER and ITR in most countries. Variations were observed in the UK and Spain likely related to overestimation of the prices for the topical agents. CONCLUSIONS: CIC lacquer avoids systemic adverse effects and is a cost-effective alternative in the treatment of mild to moderate onychomycosis without nail matrix involvement.