[A model-based comparison of cost effectiveness of imiquimod versus podophyllotoxin for the treatment of external anogenital warts in France].
OBJECTIVE
For the National health scheme, to compare the costs and the efficacy of treatment of external anogenital warts with imiquimod and podophyllotoxin and laser therapy in the case of failure or relapse.


METHODS
A model simulating the two successive treatments was built. In the first phase, the two topical treatments applied by the patients: podophyllotoxin for 4 weeks and imiquimod for 16 weeks were compared. In the case of failure or relapse, laser therapy that is widely used in France in this indication and, was applied. The efficacy of the topical treatments was assessed after reanalysis of the results of two controlled clinical trials versus placebo. These two trials were retained because they were comparable in method and had been recently published at the same time. A review of the literature assessed the results of laser therapy. A survey was conducted to collect the medical resources consumed by the different treatments.


RESULTS
Imiquimod provided a clearance rate of 49.5 p. 100, i.e., the disappearance of the lesions at 16 weeks, greater than that of podophyllotoxin (28.3 p. 100) at 4 weeks. The relapse rate was lowest with imiquimod (13.3 p. 100) than with podophyllotoxin (30.9 p. 100). The remission rate without relapse 3 months after the end of treatment was, including the laser, of 62 p. 100 following imiquimod and of 47 p. 100 following podophyllotoxin. The costs per patient cured was of 668 Euros for imiquimod and of 689 Euros for podophyllotoxin.


CONCLUSIONS
Imiquimod, because of its greater initial efficacy, is at least as cost-effective as podophyllotoxin the treatment of external genital warts.
Cemka, Bourg-la-Reine. antoine.lafuma@cemka.fr
A
A
Lafuma
J
J
Monsonego
M
M
Moyal-Barracco
C
C
Pribil
D000276:Adjuvants, Immunologic / Q000191:economics* / Q000627:therapeutic use*; D000328:Adult; D000634:Aminoquinolines / Q000191:economics* / Q000627:therapeutic use*; D000972:Antineoplastic Agents, Phytogenic / Q000191:economics* / Q000627:therapeutic use*; D001004:Anus Diseases / Q000188:drug therapy* / Q000628:therapy; D003218:Condylomata Acuminata / Q000188:drug therapy* / Q000628:therapy; D003362:Cost-Benefit Analysis; D003663:Decision Trees; D005260:Female; D005602:France; D005831:Genital Diseases, Female / Q000188:drug therapy* / Q000628:therapy; D005832:Genital Diseases, Male / Q000188:drug therapy* / Q000628:therapy; D006801:Humans; D000077271:Imiquimod; D053685:Laser Therapy; D008297:Male; D011034:Podophyllotoxin / Q000191:economics* / Q000627:therapeutic use*
D000276:Adjuvants, Immunologic; D000634:Aminoquinolines; D000972:Antineoplastic Agents, Phytogenic; D011034:Podophyllotoxin; D000077271:Imiquimod