Costs of therapy for dermatophyte infections

The price of drugs is an important consideration in the determination of the therapy's cost effectiveness. In this article the cost of antifungal drugs to several pharmacies (from a wholesaler) is calculated for topical and oral drug regimens to treat three hypothetical patients with dermatophyte infections. Drug costs to pharmacies for the topical treatment of tinea varied greatly--more than 14-fold (for 4-week courses, from $11.14 for miconazole to $156.72 for terbinafine). Costs to pharmacies of oral drugs for tinea also varied considerably, although the degree of difference depended on the regimens used for fluconazole and itraconazole, for which optimal dosages and durations of therapy have not been determined and for which this use is not approved by the Food and Drug Administration. Given the frequency of these infections and the importance of outcomes in addition to clinical cure (such as prevention of relapse), this difference highlights the need for formal studies to compare drug effectiveness in combination with cost.