德国抗真菌药物治疗趾甲甲真菌病的经济学评价

Economic evaluation of antifungal agents in the treatment of toenail onychomycosis in Germany.

作者信息

Van Doorslaer E K, Tormans G, Gupta A K, Van Rossem K, Eggleston A, Dubois D J, De Doncker P, Haneke E

机构信息

Institute for Medical Technology Assessment, Erasmus University, Rotterdam, The Netherlands.

出版信息

Dermatology. 1996;193(3):239-44. doi: 10.1159/000246254.

DOI:10.1159/000246254

PMID:8944348

Abstract

BACKGROUND

The strategies for the management of onychomycosis have changed since the availability of the newer generation of antifungal agents, particularly, itraconazole and terbinafine. Itraconazole (1-week pulse) therapy may have higher efficacy and an improved adverse-effects profile compared to the continuous therapy regimen.

OBJECTIVE

We performed a pharmacoeconomic evaluation of the most commonly used treatments in Germany for toenail onychomycosis from a health care payer perspective.

METHODS

A 5-step approach was used. Firstly, the purpose of the study, the comparator drugs, their dosage regimens and the time frame of the analysis were defined. Next, the medical practice and resource consumption patterns associated with the treatment of onychomycosis were identified. In step III, a meta-analysis was used to determine the relative efficacy of the comparator drugs. In step IV, a decision tree of the treatment algorithms was constructed for each comparator. The expected cost analysis and cost-effectiveness analysis were also performed. Finally, a sensitivity analysis was carried out.

RESULTS

For the four main comparator drugs used to treat toenail onychomycosis in Germany, the clinical response rates (clinical cure plus marked improvement) at the end of the follow-up period (month 12 after starting therapy) were, for itraconazole (1-week pulse dosing): 89.8 +/- 3% (mean +/- SE), terbinafine: 79.4 +/- 10%, itraconazole (continuous dosing): 77.5 +/- 9%, and ciclopirox nail varnish: 55 +/- 5%. Itraconazole (1-week pulse dosing) was most cost-effective at DM 1,107 per successful treatment, followed by oral terbinafine at DM 1,224, ciclopirox nail varnish and itraconazole (continuous dosing). Sensitivity analyses indicated that itraconazole (1-week pulse dosing) and terbinafine had similar cost-effectiveness ratios.

CONCLUSION

Itraconazole is an effective, broad-spectrum triazole used as continuous or pulse therapy in the treatment of onychomycosis. Itraconazole (1-week pulse) and terbinafine are the most cost-effective therapies for toenail onychomycosis.

摘要

背景

自从新一代抗真菌药物，特别是伊曲康唑和特比萘芬问世以来，甲癣的治疗策略发生了变化。与连续治疗方案相比，伊曲康唑（1周冲击疗法）治疗可能具有更高的疗效和更好的不良反应谱。

目的

从医疗保健支付方的角度，我们对德国治疗趾甲甲癣最常用的治疗方法进行了药物经济学评价。

方法

采用五步方法。首先，确定研究目的、对照药物、其给药方案和分析的时间范围。其次，确定与甲癣治疗相关的医疗实践和资源消耗模式。第三步，使用荟萃分析确定对照药物的相对疗效。第四步，为每种对照药物构建治疗算法的决策树。还进行了预期成本分析和成本效益分析。最后，进行敏感性分析。

结果

对于德国用于治疗趾甲甲癣的四种主要对照药物，在随访期结束时（开始治疗后12个月）的临床缓解率（临床治愈加显著改善）为，伊曲康唑（1周冲击给药）：89.8±3%（平均值±标准误），特比萘芬：79.4±10%，伊曲康唑（连续给药）：77.5±9%，环吡酮甲涂剂：55±5%。伊曲康唑（1周冲击给药）最具成本效益，每次成功治疗费用为1107德国马克，其次是口服特比萘芬，费用为1224德国马克，环吡酮甲涂剂和伊曲康唑（连续给药）。敏感性分析表明，伊曲康唑（1周冲击给药）和特比萘芬具有相似的成本效益比。