A COST-ANALYSIS OF TOPICAL DRUG REGIMENS FOR DERMATOPHYTE INFECTIONS

Objective.-To examine the extra cost of using higher-priced drugs as i nitial therapy for dermatophyte infections, because the many available effective drugs vary considerably in cost. Design.-Cost analysis from the purchaser's perspective, comparing two prototypical regimens to t reat tinea pedis: one in which all patients initially receive a fewer- priced drug and those with unresponsive infections receive a higher-pr iced drug at a follow-up office visit, and one in which all patients r eceive the higher-priced drug from the outset. The reference drug was miconazole, an imidazole available without a prescription, for which r eported overall efficacy rates are 70% to 100%. Main Outcome Measures. -The threshold efficacy rate (the efficacy rate of miconazole below wh ich it is always less expensive to use a specific higher-priced drug f irst) and the extra cost (of beginning therapy with a higher-priced dr ug). Results.-Assuming the Medicare-approved charge for a follow-up vi sit ($21.98), it is less expensive to begin therapy with a prescriptio n drug only if the efficacy rate of miconazole is less than 55%; this threshold efficacy rate varied from 26% (for a $0 total cost of the fo llow-up visit) to 79% (for an $89 total cost of the follow-up visit). If the efficacy rate of miconazole is 70%, the extra cost per patient for all patients to receive the least expensive prescription antifunga l drug instead of miconazole first was $15.23 and $8.64 if total visit costs were $0 and $21.98, miconazole remained the less expensive alte rnative as long as the total cost of the follow-up visit was less than $50.76. Conclusion.-For reported efficacy rates and standard costs of a follow-up office visit, using miconazole first and then treating on ly those patients with unresponsive infections with a higher-priced pr escription drug is less expensive than treating ail patients with the higher-priced drug.