Cost of treatment for onychomycosis - Data from a 9-month observational study

Objectives: To estimate component and total costs of treatment and to exami ne differences in cost and cost effectiveness between oral antifungal medic ation and local therapy for patients with toenail onychomycosis. Design: Prospective, observational study of patients with onychomycosis who visited dermatologists and podiatrists in the US. Physicians provided data on clinical management, disease severity, nail improvement and resource ut ilisation. Patients completed questionnaires on resource utilisation and sy mptoms at baseline. 4 and 9 months. To estimate costs, reported utilisation was multiplied by unit costs expressed in 1997 US dollars ($US) and derive d in 2 ways: first. using Medicare fees; and second, using standard physici an fees. Results: After adjustment for key demographic and clinical variables. parti cipants receiving oral medication had higher total costs based on standard fees ($US794 vs $US575) and medication costs ($US564 vs $US109), lower proc edure costs ($US0 vs $US122) and physician visit costs ($US200 vs $US330), and greater clinical effectiveness as measured by global improvement rating (86 vs 35%) and Toenail Symptom Index (94 vs 49%). For participants receiv ing oral medication. 90% of total costs were incurred during the first 4 mo nths of followup, whereas for those receiving local therapy, costs were mor e evenly distributed throughout the study period. Incremental cost-effectiv eness analysis showed $US304 to $US491 per additional case improved with or al medication over a 9-month timeframe. Extrapolation of these results usin g 2 time-points (months 4 and 9) suggested that cost equivalence would be r eached 17 to 21 months following the initiation of treatment. Conclusions: During 9 months of follow-up in patients with toenail onychomycosis, the us e of oral antifungal medication resulted in superior patient outcomes. but at higher total cost compared with local therapy.