CLINICAL AND COST CONSIDERATIONS IN THE PHARMACOTHERAPY OF VULVO-VAGINAL CANDIDIASIS

Vulvovaginal candidiasis (VVC) is a frequent cause of morbidity in wom en of reproductive age. Most women will experience 1 or 2 episodes in their lifetime, but a smaller population develop chronic recurrent dis ease. There are few data on cost or pharmacoeconomic considerations in the management of this condition. The disease does not usually result in long term disability, loss of employment or death, but could affec t a woman's work performance through irritability, frustration and unh appiness. This review attempts to estimate the least costly programme or regimen (as the efficacy of different regimens is similar) that wou ld be applicable to patients, third-party payers and society. Nonpresc ription or over-the-counter (OTC) antifungal preparations could have a n impact on overall cost in the management of VVC. In the management o f infrequent acute VVC, an OTC preparation would be least costly to th e healthcare system (provided that the diagnosis was correct). The str ategies used to control symptoms inpatients with chronic recurrent VVC should be based on the frequency of recurrent episodes. For patients with less than 12 episodes a year, empirical self-treatment at the ons et of symptoms with an OTC agent (e.g. intravaginal clotrimazole 500mg ) is less costly and preferable to patients than monthly prophylaxis. Patients with a greater frequency of recurrences may benefit from mont hly, daily or twice weekly prophylaxis. At present, for very frequent recurrences, intravaginal clotrimazole 200mg twice weekly appears to b e as effective as daily oral ketoconazole, and may be safer and less c ostly. However, because of the lack of prospective controlled studies, most of these recommendations are based on hypothetical reasonings. F urthermore, the disadvantages of OTC antifungals include the potential for overuse and inappropriate use, possibly resulting in the delayed diagnosis and treatment of other conditions. On balance, OTC preparati ons may provide patients with faster and more economical care, and imp rove healthcare delivery.