A cost analysis of topical drug regimens for dermatophyte infections
M. M. Chren and C. S. Landefeld
Department of Dermatology, Cleveland Veterans Affairs Medical Center, OH 44106.
OBJECTIVE--To examine the extra cost of using higher-priced drugs as
initial 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 treat tinea
pedis: one in which all patients initially receive a lower-priced drug and
those with unresponsive infections receive a higher-priced drug at a
follow-up office visit, and one in which all patients receive the
higher-priced drug from the outset. The reference drug was miconazole, an
imidazole available without a prescription, for which reported overall
efficacy rates are 70% to 100%. MAIN OUTCOME MEASURES--The threshold
efficacy rate (the efficacy rate of miconazole below which it is always
less expensive to use a specific higher-priced drug first) and the extra
cost (of beginning therapy with a higher-priced drug). RESULTS--Assuming
the Medicare-approved charge for a follow-up visit ($21.98), it is less
expensive to begin therapy with a prescription 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 follow-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 antifungal 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 alternative 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 only those patients with unresponsive infections
with a higher-priced prescription drug is less expensive than treating all
patients with the higher-priced drug.
