title: Cost-effectiveness analysis for onychomycosis therapy in Canada from a government perspective.
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)
authors.affiliation: Faculty of Pharmacy, University of Toronto, Ontario, Canada.
authors.forename: T R
authors.initials: TR
authors.lastname: Einarson
authors.forename: S R
authors.initials: SR
authors.lastname: Arikian
authors.forename: N H
authors.initials: NH
authors.lastname: Shear
mesh_terms: D000935:Antifungal Agents / Q000191:economics*; D002170:Canada; D003362:Cost-Benefit Analysis; D005533:Foot Dermatoses / Q000188:drug therapy; D006118:Griseofulvin / Q000191:economics; D006229:Hand Dermatoses / Q000188:drug therapy; D006801:Humans; D007654:Ketoconazole / Q000191:economics; D009281:Naphthalenes / Q000191:economics; D014009:Onychomycosis / Q000188:drug therapy / Q000191:economics*; D000077291:Terbinafine
chemical_list: D000935:Antifungal Agents; D009281:Naphthalenes; D006118:Griseofulvin; D000077291:Terbinafine; D007654:Ketoconazole