title: Cost-effectiveness analysis of tacrolimus ointment versus high-potency topical corticosteroids in adults with moderate to severe atopic dermatitis.
abstract: BACKGROUND
  Few cost-effectiveness analyses have been conducted on topical therapies for atopic dermatitis.
  
  
  OBJECTIVE
  We sought to compare cost-effectiveness of high-potency topical corticosteroids (HPTCs) and tacrolimus ointment for the treatment of moderate to severe atopic dermatitis for patients who are not responsive to or not well controlled with mid-potency topical corticosteroids.
  
  
  METHODS
  A Markov model represented the cyclic nature of atopic dermatitis. Clinical outcomes were derived from published literature. "Efficacy" was defined as disease-controlled days on which patients experienced a greater than 75% improvement in their disease. Resource use and changes in management were on the basis of opinions of a physician panel; secondary treatment was an oral antibiotic with topical corticosteroids. Sensitivity analyses were conducted for all variables.
  
  
  RESULTS
  The model was sensitive to duration of continuous treatment with HPTCs. HPTCs, when limited to 2-week treatment cycles, were associated with the highest total costs ($1682 per year) and the least efficacy (185 disease-controlled days). HPTCs in 4-week treatment intervals and tacrolimus ointment were similar in total costs and efficacy ($1317 vs $1323 for 194 vs 190 disease-controlled days, respectively). Although primary drug costs were higher for patients treated with tacrolimus ointment, patients treated with regimens of HPTCs incurred higher secondary drug costs.
  
  
  CONCLUSIONS
  In the base case analyses, tacrolimus ointment was more cost-effective than HPTCs administered in 2-week treatment cycles, and similar in cost-effectiveness to 4-week cycles of HPTCs.
authors.affiliation: Department of Dermatology, University of Michigan Medical School, Ann Arbor 48109-0314, USA.
authors.forename: Charles N
authors.initials: CN
authors.lastname: Ellis
authors.forename: Lynn A
authors.initials: LA
authors.lastname: Drake
authors.forename: Mary M
authors.initials: MM
authors.lastname: Prendergast
authors.forename: William
authors.initials: W
authors.lastname: Abramovits
authors.forename: Mark
authors.initials: M
authors.lastname: Boguniewicz
authors.forename: C Ralph
authors.initials: CR
authors.lastname: Daniel
authors.forename: Mark
authors.initials: M
authors.lastname: Lebwohl
authors.forename: Amy S
authors.initials: AS
authors.lastname: Paller
authors.forename: Seth R
authors.initials: SR
authors.lastname: Stevens
authors.forename: Diane L
authors.initials: DL
authors.lastname: Whitaker-Worth
authors.forename: Kuo B
authors.initials: KB
authors.lastname: Tong
mesh_terms: D000287:Administration, Topical; D000328:Adult; D000893:Anti-Inflammatory Agents / Q000008:administration & dosage / Q000191:economics*; D003362:Cost-Benefit Analysis; D003876:Dermatitis, Atopic / Q000188:drug therapy* / Q000191:economics*; D005938:Glucocorticoids; D017048:Health Care Costs; D006801:Humans; D007166:Immunosuppressive Agents / Q000008:administration & dosage / Q000191:economics*; D008390:Markov Chains; D009824:Ointments; D012008:Recurrence; D019233:Retreatment; D016559:Tacrolimus / Q000008:administration & dosage / Q000191:economics*; D016896:Treatment Outcome
chemical_list: D000893:Anti-Inflammatory Agents; D005938:Glucocorticoids; D007166:Immunosuppressive Agents; D009824:Ointments; D016559:Tacrolimus