Treating Bowen's disease: a cost-minimization study.
BACKGROUND
In the current economic climate, it is important to justify the cost of treatments used in dermatology, particularly where cheaper alternatives exist.


OBJECTIVE
To determine which treatment modality commonly used for Bowen's disease is associated with the lowest cost to the National Health Service.


METHODS
A cost-minimization analysis was used to compare the following six treatments for Bowen's disease: cryotherapy, curettage and cautery, excision, laser ablation, photodynamic therapy and 5-fluorouracil. These are all known to have similar recurrence rates. Information regarding use of these treatment modalities was extracted from a literature review. Costs were determined from published data, average wholesale prices of medications, staff salary pay scales and health economics departments.


RESULTS
The results show that, if treatment is indeed undertaken, a single lesion of Bowen's disease is most cheaply treated by curettage or excision biopsy under local anaesthetic, and most expensively treated by photodynamic therapy. The usefulness of this information has to be taken in the context of the study design, outcome measurements and base assumptions.


CONCLUSIONS
Valid costing studies such as this, in conjunction with evidence of effectiveness and safety, can provide guidance for resource allocation and treatment decisions.
Ramrakha-Jones
V S
VS
Department of Dermatology, Southern General Hospital, 1345 Govan Road, Glasgow G51 4TF, UK. davana@doctors.org.uk
Herd
R M
RM
D000963:Antimetabolites / Q000191:economics / Q000627:therapeutic use; D001706:Biopsy / Q000191:economics; D001913:Bowen's Disease / Q000191:economics* / Q000628:therapy; D003362:Cost-Benefit Analysis; D003365:Costs and Cost Analysis; D017679:Cryotherapy / Q000191:economics; D003475:Curettage / Q000191:economics; D005472:Fluorouracil / Q000191:economics / Q000627:therapeutic use; D006801:Humans; D053685:Laser Therapy / Q000191:economics; D010778:Photochemotherapy / Q000191:economics; D013222:State Medicine / Q000191:economics*
D000963:Antimetabolites; D005472:Fluorouracil