Inserm CIC1410, CHU Réunion, Saint Pierre, La Réunion, France.
Cabinet de Dermatologie, 05130 Tallard, France.
Ann Dermatol Venereol. 2024 Sep;151(3):103288. doi: 10.1016/j.annder.2024.103288. Epub 2024 Jul 15.
No treatment hierarchy for external anogenital warts (AGW) is currently recommended, despite wide variations in the costs of available treatments. The aim of this study was to propose a treatment hierarchy based on a health economic analysis of local treatments for AGW from the perspective of the French health insurance system.
Thirteen treatments and 73 treatment sequences were evaluated for AGW clearance and absence of AGW recurrence at 3 months of follow-up. The cost per treatment included the cost of consultations, drugs, medical procedures, and dressings. The time horizon was one year. The least expensive treatment was used as the reference treatment in the calculation of incremental cost-effectiveness ratios (ICERs). A two-line decision tree for treatment was constructed.
Podophyllotoxin 0.5% solution was the least expensive treatment. Compared to podophyllotoxin 0.5% solution, the most cost-effective treatment was surgical excision (ICER: €456.82) and the most cost-effective treatment sequence was podophyllotoxin 0.5% solution followed by 5-fluorouracil (5-FU) 5% cream.
Considering the high risk of bias in the randomized controlled trials considered, the most cost-effective treatment sequence was podophyllotoxin 0.5% solution followed by 5-FU 5% cream.
尽管现有治疗方法的成本存在广泛差异，但目前对外生殖器疣（AGW）尚无治疗等级制度。本研究旨在从法国健康保险体系的角度出发，通过对外生殖器疣局部治疗的健康经济分析，提出一种治疗等级制度。
评估了 13 种治疗方法和 73 种治疗方案，以评估其在 3 个月随访时清除和不存在 AGW 复发的效果。每种治疗方法的费用均包括咨询费、药品费、医疗程序费和敷药费。时间范围为一年。最便宜的治疗方法被用作计算增量成本效益比（ICER）的参照治疗方法。构建了一个用于治疗的两线决策树。
鬼臼毒素 0.5%溶液是最便宜的治疗方法。与鬼臼毒素 0.5%溶液相比，最具成本效益的治疗方法是手术切除（ICER：456.82 欧元），最具成本效益的治疗方案是鬼臼毒素 0.5%溶液序贯 5-氟尿嘧啶（5-FU）5%乳膏。
考虑到纳入的随机对照试验存在高度偏倚风险，最具成本效益的治疗方案是鬼臼毒素 0.5%溶液序贯 5-FU 5%乳膏。
