Pharmacoeconomic issues in onychomycosis.

The importance of health economics (the application of economics to healthcare and medicine) has grown significantly in recent years as the need to maximize the use of limited healthcare resources has increased. The role of pharmacoeconomics (the application of health economics to pharmaceuticals) is to provide a method that evaluates outcomes and costs of treatment at the same time, thus providing an aid to better decision-making. However, there remains some uncertainty within the medical community about the usefulness of pharmacoeconomic data. Reasons for this include a poor understanding of the purpose and outcome of pharmacoeconomic studies, inconsistent use of terminology, and a perception that freedom of choice of prescriptions is restricted. To optimize the medical management of patients with severe onychomycosis, two pharmacoeconomic evaluations of amorolfine were undertaken. In a comparison of topical amorolfine + oral terbinafine vs. oral terbinafine alone, treatment with the topical/oral combination for a period of up to 12 weeks resulted in an improved outcome compared with the oral drug alone. A second study with topical amorolfine + oral itraconazole showed that treatment for a period of 6 weeks was the preferred cost-effective treatment option. While combination therapy might seem to be a more costly option, pharmacoeconomic studies have clearly shown that treatment of onychomycosis with amorolfine, in combination with either oral terbinafine or oral itraconazole, is both cost-saving and cost-effective compared with oral treatment alone.