Modeling the impact of treatment options in genital warts: Patient-appliedversus physician-administered therapies

With the availability of new patient-applied treatments for genital and per ianal warts, medical providers, physician groups, and health systems are re assessing the role of physician-administered therapies. Two key questions a re: how cost-effective are physician- versus patient-administered therapies and, given patient preferences for the convenience and privacy associated with the latter therapies, which of the 2 presently available treatments-im iquimod and podofilox-is most appropriate? The purpose of this article is t o examine, from the perspective of the health care purchaser, these questio ns and to undertake a pharmacoeconomic analysis of the direct cost-effectiv eness of therapy options, given targets being set for the outcomes of genit al warts therapy. The analysis employs a synthetic, decision-modeling frame work in which data on sustained clearance and the direct costs of treatment are drawn from both clinical studies and previous studies on the resources used to support treatment. Once targets are set-and it is proposed here th at physicians should aim for at least a 50% sustained clearance rate for ge nital warts-it becomes clear that in cost per sustained clearance terms, im iquimod, as first-line therapy, is the most cost-effective intervention. If we compare imiquimod with podofilox as first-line therapy (with clyotherap y as the second-line option), the cost per sustained clearance for the imiq uimod treatment sequence is $1367 compared with the podofilox-initiated seq uence of $1508.