title: Cost-effectiveness of a hydroquinone/tretinoin/fluocinolone acetonide cream combination in treating melasma in the United States.
abstract: BACKGROUND
  Melasma, a disorder of facial hyperpigmentation, presents a treatment obstacle to many physicians. Combination therapy with hydroquinone, tretinoin, and fluocinolone acetonide has proven effective, but it is generally more expensive than other treatments.
  
  
  OBJECTIVE
  To assess the cost-effectiveness of daily triple combination therapy (TCT) compared with daily use of each possible pair of agents (dyads) and twice daily use of hydroquinone (HQ) alone from a payer's perspective.
  
  
  METHODS
  Efficacy data were obtained from two clinical trials with the primary endpoint being complete clearance at 8 weeks. For all treatments, total cost per successful treatment was calculated. The incremental cost-effectiveness ratio (ICER) was calculated for each dyad and for HQ monotherapy in comparison with TCT. Sensitivity analyses for efficacy and number of office visits were similarly performed.
  
  
  CONCLUSIONS
  TCT consistently had the lowest cost per primary success in all the analyses performed. Furthermore, ICERs were low, indicating that TCT's superior efficacy is attained at marginal cost increases. Our results indicate that TCT is the most cost-effective treatment when compared with any of its dyads or with hydroquinone alone.
authors.affiliation: School of Medicine, University of California at Davis, Sacramento, California, USA. alialikhan1@yahoo.com
authors.forename: Ali
authors.initials: A
authors.lastname: Alikhan
authors.forename: Meaghan
authors.initials: M
authors.lastname: Daly
authors.forename: Jun
authors.initials: J
authors.lastname: Wu
authors.forename: Rajesh
authors.initials: R
authors.lastname: Balkrishnan
authors.forename: Steven R
authors.initials: SR
authors.lastname: Feldman
mesh_terms: D000279:Administration, Cutaneous; D002986:Clinical Trials as Topic; D003362:Cost-Benefit Analysis; D003879:Dermatologic Agents / Q000008:administration & dosage / Q000191:economics*; D004338:Drug Combinations; D016527:Drug Costs; D004359:Drug Therapy, Combination / Q000191:economics; D005446:Fluocinolone Acetonide / Q000008:administration & dosage / Q000191:economics*; D006801:Humans; D006873:Hydroquinones / Q000008:administration & dosage / Q000191:economics*; D008548:Melanosis / Q000188:drug therapy* / Q000191:economics*; D009824:Ointments; D016896:Treatment Outcome; D014212:Tretinoin / Q000008:administration & dosage / Q000191:economics*; D014481:United States
chemical_list: D003879:Dermatologic Agents; D004338:Drug Combinations; D006873:Hydroquinones; D009824:Ointments; D005446:Fluocinolone Acetonide; D014212:Tretinoin; C031927:hydroquinone