title: Cost effectiveness of oral terbinafine (Lamisil) compared with oral fluconazole (Diflucan) in the treatment of patients with toenail onychomycosis.
abstract: OBJECTIVE
  To determine the cost effectiveness of terbinafine (Lamisil) tablets compared with fluconazole (Diflucan) capsules in the treatment of patients with toenail onychomycosis.
  
  
  METHODS
  Data from a randomised, double-blind, double-dummy, multicentre study were used as the basis for this study. Terbinafine 250 mg/day for 12 weeks (n = 48) was compared with fluconazole 150mg once weekly for 12 weeks (n = 45) or 24 weeks (n = 44) in patients with culture-confirmed toenail onychomycosis caused by dermatophyte infection. At the end of the study (week 60), complete clinical cure of the target toenail was achieved in 67% of patients in the terbinafine group, compared with 21 and 32%, respectively, in the 12- and 24-week fluconazole groups. We subsequently used these data to calculate the cost effectiveness of the three treatment regimens, defining cost effectiveness as the cost per complete clinical cure of the target toenail at week 60.
  
  
  RESULTS
  The cost effectiveness of terbinafine for each complete clinical cure was superior to that of either of the fluconazole regimens. Costs per cure were Finnish markka (Fmk) 2824 ($US618) for terbinafine, compared with Fmk3748 ($US820) and Fmk4922 ($US1077), respectively, for the two fluconazole regimens.
  
  
  CONCLUSIONS
  The clinical study showed that terbinafine was significantly more effective than fluconazole in the treatment of onychomycosis, achieving statistically higher rates of mycological and clinical cure. We have now shown that terbinafine is also more cost effective. These findings have important implications for both medical and social policy.
authors: Health Services Research Ltd, Helsinki, Finland.
authors: Heini
authors: H
authors: Salo
authors: Markku
authors: M
authors: Pekurinen
mesh_terms: D000284:Administration, Oral; D000328:Adult; D000368:Aged; D000935:Antifungal Agents / Q000627:therapeutic use*; D003362:Cost-Benefit Analysis; D004311:Double-Blind Method; D005260:Female; D015725:Fluconazole / Q000008:administration & dosage / Q000191:economics / Q000627:therapeutic use*; D005533:Foot Dermatoses / Q000188:drug therapy; D006801:Humans; D008297:Male; D008875:Middle Aged; D009281:Naphthalenes / Q000008:administration & dosage / Q000191:economics / Q000627:therapeutic use*; D014009:Onychomycosis / Q000188:drug therapy*; D000077291:Terbinafine
chemical_list: D000935:Antifungal Agents; D009281:Naphthalenes; D015725:Fluconazole; D000077291:Terbinafine