Penna Pete, Meckfessel Matthew H, Preston Norman
Principal and Cofounder, Formulary Resources, LLC, Mercer Island, WA.
Medical Writer, Galderma Laboratories, LP, Fort Worth, TX.
Am Health Drug Benefits. 2014 Jan;7(1):37-45.
Acne vulgaris is a chronic skin disease with a high prevalence. Left untreated or inadequately treated, acne vulgaris can lead to psychological and physical scarring, as well as to unnecessary medical expenses. Oral isotretinoin is an effective treatment for severe resistant nodular and conglobate acne vulgaris. A regimen consisting of a fixed-dose combination of adapalene and benzoyl peroxide gel, 0.1%/2.5% (A-BPO) with oral doxycycline 100 mg (A-BPO/D) has been demonstrated to be efficacious and well tolerated in patients with severe acne and may be an alternative to oral isotretinoin for some patients with severe acne.
The objective of this analysis was to compare the relative efficacy and associated costs of A-BPO/D versus oral isotretinoin.
In this analysis, comparisons of relative efficacy were made using previously published studies involving similar patient populations with severe acne that warrant the use of oral isotretinoin. The pricing for oral doxycycline and oral isotretinoin was estimated based on the maximum allowable cost from 9 states, and the pricing for A-BPO was calculated as the range between the average wholesale price and the wholesale acquisition cost. For this analysis, 2 treatment models were generated to compare costs: (1) a basic treatment model that examined the costs of an initial regimen of either A-BPO/D or oral isotretinoin without considering probable outcomes, and (2) a long-term model that factored in likely treatment outcomes and subsequent treatments into associated costs. The basic treatment model assumed that patients would be prescribed a single regimen of A-BPO/D for 12 weeks or oral isotretinoin for 20 weeks. The long-term model considered the probability of each treatment successfully managing patients' acne, as well as likely additional regimens of A-BPO monotherapy or an additional regimen of oral isotretinoin. As a result of different treatment durations, the costs for each treatment were normalized to weekly cost of treatment.
Based on evidence from the published literature, patients treated with A-BPO/D would be expected to have an initial 72% reduction in inflammatory lesions, and patients treated with oral isotretinoin would have an 80% to 90% reduction of these lesions. The median weekly cost for the basic treatment model was $44 for A-BPO/D and $62 for oral isotretinoin. The weekly median costs for the long-term model were $44 for patients initially receiving a regimen of A-BPO/D followed by a maintenance regimen of A-BPO monotherapy and $50 for patients receiving an initial regimen of A-BPO/D who required a subsequent regimen of oral isotretinoin. The weekly cost for oral isotretinoin in the long-term model was $62.
The comparison of these 2 treatments demonstrated that they are both effective in treating severe acne, and that A-BPO/D was less expensive weekly than oral isotretinoin. These models show that A-BPO/D is safer than and is a more cost-effective alternative to oral isotretinoin for treating patients with severe acne vulgaris.
寻常痤疮是一种患病率很高的慢性皮肤病。若不治疗或治疗不当，寻常痤疮会导致心理和身体上的瘢痕形成，以及不必要的医疗费用。口服异维A酸是治疗重度耐药结节性和聚合性寻常痤疮的有效方法。一种由0.1%/2.5%的阿达帕林和过氧化苯甲酰凝胶（A - BPO）与100毫克口服多西环素（A - BPO/D）组成的固定剂量联合方案，已被证明对重度痤疮患者有效且耐受性良好，对于一些重度痤疮患者而言可能是口服异维A酸的替代方案。
本分析的目的是比较A - BPO/D与口服异维A酸的相对疗效及相关成本。
在本分析中，使用先前发表的涉及类似重度痤疮患者群体（这些患者需要使用口服异维A酸）的研究进行相对疗效比较。基于9个州的最高允许成本估算口服多西环素和口服异维A酸的价格，A - BPO的价格计算为平均批发价与批发采购成本之间的范围。为进行此分析，生成了2种治疗模型以比较成本：（1）基本治疗模型，该模型在不考虑可能结果的情况下检查A - BPO/D或口服异维A酸初始方案的成本；（2）长期模型，该模型将可能的治疗结果和后续治疗纳入相关成本。基本治疗模型假设患者将接受A - BPO/D单一方案治疗12周或口服异维A酸治疗20周。长期模型考虑了每种治疗成功控制患者痤疮的概率，以及A - BPO单一疗法的可能额外方案或口服异维A酸的额外方案。由于治疗持续时间不同，每种治疗的成本按每周治疗成本进行标准化。
根据已发表文献的证据，预计接受A - BPO/D治疗的患者炎症性皮损最初会减少72%，接受口服异维A酸治疗的患者这些皮损会减少80%至90%。基本治疗模型的每周中位成本，A - BPO/D为44美元，口服异维A酸为62美元。长期模型的每周中位成本，最初接受A - BPO/D方案随后接受A - BPO单一疗法维持方案的患者为44美元，最初接受A - BPO/D方案但随后需要口服异维A酸方案的患者为50美元。长期模型中口服异维A酸的每周成本为62美元。
这两种治疗方法的比较表明，它们在治疗重度痤疮方面均有效，且A - BPO/D每周的费用低于口服异维A酸。这些模型表明，对于治疗重度寻常痤疮患者，A - BPO/D比口服异维A酸更安全且更具成本效益。
