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Cost-effectiveness analysis for onychomycosis therapy in Canada from a government perspective
T R Einarson1, S R Arikian, N H Shear
1Faculty of Pharmacy, University of Toronto, Ontario, Canada.
Abstract:
An economic analysis of the oral antifungal drugs griseofulvin (GRI), ketoconazole (KET), and terbinafine (TER), currently registered and used in treating onychomycosis of fingernails and toenails, was performed using a model that incorporates elements of both meta-analysis and pharmacoeconomics. The meta-analysis of published studies determined rates of success, relapse and side-effects. The perspective taken for the analysis was that of the government payer, with expected total cost and cost-effectiveness being calculated. A multiphase approach was used. The studies of onychomycosis of the fingernails showed that TER had a 95.0% success rate, KET 80.9%, and GRI 59.6%. GRI had the lowest acquisition costs. The success rates for onychomycosis of the toenails were: TER 78.3%, KET 40.8%, and GRI 17.5%. GRI had the lowest acquisition costs. However, expected cost comparison showed TER had the lowest cost because of shorter treatment duration. The expected cost of therapy with a 100% government payer perspective for fingernail onychomycosis was the lowest for TER ($439.83), followed by GRI ($480.80), then KET ($755.46). Toenail onychomycosis showed the same order for the comparators, with TER $1049.77, GRI $1388.54 and KET $1936.48. When compared with TER, fingernail cost-effectiveness ratios for GRI and KET were 1.51 and 2.00. Toenail cost-effectiveness ratios were 2.49 and 2.48, respectively. For both fingernail and toenail onychomycosis, TER had the greatest number of disease-free days (973 for fingernails; 1073 for toenails), followed by KET (837; 798), then GRI (702; 569).(ABSTRACT TRUNCATED AT 250 WORDS)
Insights
Terbinafine (TER) is the most cost-effective oral antifungal for onychomycosis, offering the highest success rates and most disease-free days despite higher acquisition costs. Griseofulvin (GRI) and ketoconazole (KET) are less effective and more costly overall.
Area of Science:
- Pharmacoeconomics
- Dermatology
- Infectious Diseases
Background:
- Onychomycosis, a fungal nail infection, requires effective and economically viable treatment options.
- Oral antifungal drugs like griseofulvin (GRI), ketoconazole (KET), and terbinafine (TER) are used for treatment.
- Economic analysis is crucial for understanding the long-term value of different therapeutic strategies.
Purpose of the Study:
- To conduct an economic analysis of GRI, KET, and TER for treating fingernail and toenail onychomycosis.
- To compare the cost-effectiveness and success rates of these oral antifungal agents from a government payer perspective.
Main Methods:
- A meta-analysis of published studies was used to determine drug efficacy (success, relapse) and side-effect rates.
- Pharmacoeconomic modeling incorporated meta-analysis data to calculate expected total costs and cost-effectiveness ratios.
- Analysis adopted a 100% government payer perspective.
Main Results:
- Terbinafine (TER) demonstrated the highest success rates for both fingernail (95.0%) and toenail (78.3%) onychomycosis.
- Despite GRI having the lowest acquisition cost, TER was the most cost-effective due to shorter treatment durations.
- TER provided the greatest number of disease-free days (973 fingernails; 1073 toenails) compared to KET and GRI.
Conclusions:
- Terbinafine (TER) is the preferred oral antifungal for onychomycosis, offering superior clinical outcomes and economic value.
- The higher initial cost of TER is offset by its greater efficacy and longer-lasting disease-free periods.
- Griseofulvin (GRI) and ketoconazole (KET) present lower cost-effectiveness for treating onychomycosis.