MULTINATIONAL PHARMACOECONOMIC ANALYSIS OF TOPICAL AND ORAL THERAPIESFOR ONYCHOMYCOSIS

BACKGROUND: Systemic antifungal agents are effective in the treatment of onychomycosis; however, they are associated with high acquisition c osts 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. P URPOSE: 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, amor olfine (AMO) and ciclopirox (CIC), and the oral agents griseofulvin (G RI), itraconazole (ITR), and terbinafine (TER) were examined using a p redictive (decision tree) model. Expert panels determined clinical pra ctice patterns, reimbursement practices and standard costs for health care resource items in each country. Metaanalysis was used to determin e clinical success rates. Data were analyzed over a 5-year horizon, wi th a 5% discounting rate. The sensitivity of the model was examined us ing rank order stability analysis (ROSA). The cost per regimen, total expected costs of therapy, and cost per symptom-free day (SFD) were ca lculated. RESULTS: CIC as first-line therapy had the lowest expected c ost 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 r elated to overestimation of the prices for the topical agents. CONCLUS IONS: CIC lacquer avoids systemic adverse effects and is a cost-effect ive alternative in the treatment of mild to moderate onychomycosis wit hout nail matrix involvement.