The cost effectiveness of patient-applied versus provider-administered intervention strategies for the treatment of external genital warts

Objective: External genital warts are one of the fastest growing sexually t ransmitted diseases in the United States today. Two forms of therapy are av ailable: provider-administered and patient-applied. In the most widely used provider-administered ablative therapies, sustained clearance rates range from 18.5% to 40.1%. With nonablative, patient-applied therapies, which are typically more acceptable to patients, sustained clearance rates range fro m 19.6% with podofilox gel to 44.0% with imiquimod cream. The purpose of th is study, given the range of therapies available, their cost differences, a nd clinical trial-reported differences in rates of sustained clearance, is to determine which therapy modalities, from the providers' perspective, are the most cost effective and which are likely to be the most acceptable to the patient population. Study Design: We consider the cost effectiveness of the two patient-applied therapies as first-line therapy followed by provider-administered ablative treatment as second-line therapy. A decision-analytic model framework is d eveloped, with data drawn both from clinical trials and from previously pub lished studies. Results: When considering a two-stage therapy model, with an average sustai ned clearance rate of 30% assumed for provider-administered ablative therap ies, estimated costs per sustained cleared patient are $1265 for patients i nitially treated with imiquimod and $1304 for patients initially treated wi th podofilox gel. Conclusions: Initial treatment with imiquimod is the preferred intervention option as it yields a 39% greater sustained clearance rate than podofilox gel while being 3% less costly per successful outcome.