An economic evaluation of intermittent cyclosporin A therapy versus UVAB phototherapy in the treatment of patients with severe atopic dermatitis.

We performed a cost-effective evaluation of cyclosporin A versus UVAB phototherapy in the treatment of severe atopic dermatitis. The analysis was based on a one-year open prospective clinical trial conducted in Finland and showed that patients who received intermittent cyclosporin A therapy had on average 191 remission days per year, i.e. where disease activity was reduced by 50% or more. Patients receiving UVAB phototherapy had on average 123 remission days per year. All costs were estimated for the one-year period. Health service utilization of the 2 treatment groups was estimated based on the data gathered during the clinical study. Total costs were USD 5,438 in the cyclosporin A group and USD 5,635 in the UVAB group. Direct health-care costs were USD 4,935 in the cyclosporin A group and USD 3,124 in the UVAB group. The cost of a remission day was USD 28 in the cyclosporin A group and USD 46 in the UVAB group. In terms of direct health-care costs, the cost of a remission day was USD 26 in the cyclosporin A group and USD 25 in the UVAB group. Our results demonstrate that cyclosporin A therapy is similarly cost-effective as UVAB phototherapy in terms of total cost in the treatment of atopic dermatitis unresponsive to topical treatment. In terms of direct health-care costs, i.e. treatment and health services utilization costs, however, UVAB is significantly less costly, but side effects are frequent.

Smoking-related costs among 25 to 59 year-old males in a 19-year individual follow-up.

OBJECTIVE: To estimate the health care expenditure and productivity losses due to smoking. DESIGN: A retrospective cohort study of a random population sample of 5,247 men aged 25-59 years from the provinces of Kuopio and North Karelia in eastern Finland. Subjects initially surveyed in 1972 were linked to a set of national registers through their social security identification numbers and followed for 19 years. The difference in the number of life years and work years lost, the costs of drugs and hospitalization, and the value of productivity lost due to disability and premature mortality between smokers, former smokers and never-smokers was analysed. RESULTS: The difference in mean life expectancy between current smokers and never-smokers was 3.0 years, and the difference in mean lost work time was 2.6 years over the 19 years of follow-up. Between current smokers and former smokers, the difference in mean life expectancy was 1.8 years, and the difference in mean lost work time was 1.6 years. The mean difference between a current smoker and a never-smoker in health service costs was [symbol: see text] 2,900, and the difference in mean total costs was [symbol: see text] 69,300 (an increase of 86%). No difference in mean health care costs between current smokers and former-smokers was found, while the difference in mean total cost was [symbol: see text] 44,000. CONCLUSIONS: Smokers incurred excess costs in terms of both direct health care expenditure and indirect productivity losses in comparison to the never-smoking population. Most importantly, quitting smoking could save at least 60% of the losses related to excess mortality and disability of smokers.

Cost effectiveness of oral terbinafine (Lamisil) compared with oral fluconazole (Diflucan) in the treatment of patients with toenail onychomycosis.

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.