Modeling the impact of treatment options in genital warts: patient-applied versus physician-administered therapies

With the availability of new patient-applied treatments for genital and perianal warts, medical providers, physician groups, and health systems are reassessing the role of physician-administered therapies. Two key questions are: 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-imiquimod and podofilox-is most appropriate? The purpose of this article is to examine, from the perspective of the health care purchaser, these questions and to undertake a pharmacoeconomic analysis of the direct cost-effectiveness of therapy options, given targets being set for the outcomes of genital warts therapy. The analysis employs a synthetic, decision-modeling framework 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 that physicians should aim for at least a 50% sustained clearance rate for genital warts--it becomes clear that in cost per sustained clearance terms, imiquimod, as first-line therapy, is the most cost-effective intervention. If we compare imiquimod with podofilox as first-line therapy (with cryotherapy as the second-line option), the cost per sustained clearance for the imiquimod treatment sequence is $1367 compared with the podofilox-initiated sequence of $1508.