Cost-effectiveness of a fixed combination of hydroquinone/tretinoin/fluocinolone cream compared with hydroquinone alone in the treatment of melasma

Journal of Drugs in Dermatology, Feb, 2007 by Tania Cestari, Lucie Adjadj, Margaret Hux, Maria Regina Shimizu, Vincent Pierre Rives

Table 1. Triple combination therapy (TCT) base case cost-effectiveness.

              Pkg   Price       Price     Cost
Available     size  per         per       per         %
treatments    (G)   tube        gram      treatment*  Success ([dagger])

USA ($)
  TCT         30         96.52      3.22       58     35.00%
  HQ          28         86.59      3.09      114      5.10%
Brazil (R$)
  TCT         15        125.00      8.33      149     35.00%
  HQ          30         35.35      1.18       43      5.10%
Chile
  (CH Pesos)
  TCT         15     40,460     2,697.33   48,282     35.00%
  HQ          40     21,910       547.75   20,212      5.10%
Argentina
  (Pesos)
  TCT         15        180.00     12.00      215     35.00%
  HQ          30         52.14      1.74       64      5.10%
Colombia
  (Pesos)
  TCT         15    120,000     8,000.00  143,200     35.00%
  HQ          40     35,900       897.50   33,118      5.10%

Available     Cost per primary           Incremental cost
treatments    success ([double dagger])  per treatment

USA ($)
  TCT             165                        -54.00
  HQ            2,183
Brazil (R$)
  TCT             426                        107.00
  HQ              832
Chile
  (CH Pesos)
  TCT         137,949                     28,563.00
  HQ          386,647
Argentina
  (Pesos)
  TCT             614                        152.23
  HQ            1,227
Colombia
  (Pesos)
  TCT         409,143                    110,890.00
  HQ          633,529

Available     Incremental  Incremental cost per
treatments    % success    additional primary success

USA ($)
  TCT         29.90%       TCT dominant ([section])
  HQ
Brazil (R$)
  TCT         29.90%           357
  HQ
Chile
  (CH Pesos)
  TCT         29.90%        95,529
  HQ
Argentina
  (Pesos)
  TCT         29.90%           509
  HQ
Colombia
  (Pesos)
  TCT         29.90%       370,870
  HQ

* Cost for treating a patient based on average usage in the clinical
trial (TCT 17.9 g, HQ 36 g).
[dagger] The proportion of patients to have complete clearing of melasma
(primary success).
[double dagger] Cost per primary success for each treatment separately
compared to choosing to not treat the melasma.
[section] TCT was found to be more effective and less costly than HQ
alone.
Pkg = package.

Table 2. Cost effectiveness sensitivity analyses related to
effectiveness.

              Base case
Available     Cost per primary     Incremental cost per additional
treatments    success* ([dagger])  primary success

USA ($)
  TCT             165              TCT dominant ([double dagger])
  HQ            2,183
Brazil (R$)
  TCT             426                  357
  HQ              832
Chile
  (CH Pesos)
  TCT         137,949               95,529
  HQ          386,647
Argentina
  (Pesos)
  TCT             614                  509
  HQ            1,227
Colombia
  (Pesos)
  TCT         409,143              370,870
  HQ          633,529

              TCT lower 95% CI limit of effectiveness [section]
Available     Cost per primary      Incremental cost per additional
treatments    success* ([section])  primary success

USA ($)
  TCT             251               TCT dominant ([double dagger])
  HQ            2,183
Brazil (R$)
  TCT             651                   599
  HQ              832
Chile
  (CH Pesos)
  TCT         210,564               160,198
  HQ          386,647
Argentina
  (Pesos)
  TCT             937                   854
  HQ            1,227
Colombia
  (Pesos)
  TCT         624,509               621,929
  HQ          633,529

              TCT upper 95% CI limit of effectiveness"
Available     Cost per primary  Incremental cost per additional
treatments    success*"         primary success

USA ($)
  TCT             122           TCT dominant ([double dagger])
  HQ            2,183
Brazil (R$)
  TCT             317               254
  HQ              832
Chile
  (CH Pesos)
  TCT         102,510            68,008
  HQ          386,647
Argentina
  (Pesos)
  TCT             456               362
  HQ            1,227
Colombia
  (Pesos)
  TCT         304,034           264,024
  HQ          633,529

* Cost per primary success for each treatment separately compared to
choosing to not treat the melasma.
[dagger] The proportion of patients to have complete clearing of melasma
(primary success) was 35% for TRILUMA and 5.1% for CLARIPEL.
[double dagger] TCT was found to he more effective and less costly than
HQ alone.
[section] For this SA, the proportion of patients to have complete
clearing was 22.9% for TRILUMA and 5.1% for CLARIPEL.
"For this SA, the proportion of patients to have complete clearing was
47.1% for TRILUMA and 5.1% for CLARIPEL.
Pkg = package.

Table 3. Cost effectiveness sensitivity analyses related to resource
use.

                               Base case
Available          Cost per primary     Incremental cost per
treatments         success* ([dagger])  additional primary success

USA ($)
  TCT                  165              TCT dominant ([double dagger])
  HQ                 2,183
Brazil (R$)
  TCT                  426                  357
  HQ                   832
Chile (CH Pesos)
  TCT              137,949               95,529
  HQ               386,647
Argentina (Pesos)
  TCT                  614                  509
  HQ                 1,227
Colombia (Pesos)
  TCT              409,143              370,870
  HQ               633,529

                            Most sold product
Available          Cost per primary      Incremental cost per
treatments         success* ([section])  additional primary success

USA ($)
  TCT                165                  14
  HQ               1,044
Brazil (R$)
  TCT
  HQ
Chile (CH Pesos)
  TCT
  HQ
Argentina (Pesos)
  TCT                614                 613
  HQ                 619
Colombia (Pesos)
  TCT
  HQ

                   Quantity of TCT used increased (upper 95% CI)
Available          Cost per primary  Incremental cost per
treatments         success*"         additional primary success

USA ($)
  TCT                  228           TCT dominant ([double dagger])
  HQ                 2,183
Brazil (R$)
  TCT                  590               549
  HQ                   832
Chile (CH Pesos)
  TCT              191,125           157,775
  HQ               386,647
Argentina (Pesos)
  TCT                  850               786
  HQ                 1,227
Colombia (Pesos)
  TCT              566,857           555,485
  HQ               633,529

                   Purchase of whole number of tubes of topical
                   treatment
Available          Cost per primary        Incremental cost per
treatments         success* ([paragraph])  additional primary success

USA ($)
  TCT                  276                 TCT
  HQ                 3,396                 dominant ([double dagger])

Brazil (R$)
  TCT                  714                     600
  HQ                 1,386
Chile (CH Pesos)
  TCT              231,200                 197,358
  HQ               429,608
Argentina (Pesos)
  TCT                1,029                     855
  HQ                 2,045
Colombia (Pesos)
  TCT              685,714                 682,609
  HQ               703,922

* Cost per primary success for each treatment separately compared to
choosing to not treat the melasma.
[dagger] Average usage of TCT in the clinical trial was 17.9 g and of HQ
was 36 g.
[double dagger] TCT was found to be more effective and less costly than
HQ.
[section] Most sold product is for: US Hydroquinone G (30 g tube for
$44.39); Argentina Neoquin (30 g tube for 26.30 pesos).
" For this SA, higher estimate of usage based on the clinical trial
(Tri-luma 24-8 and Claripel 36 g).
[paragraph] For this SA, it is assumed that based on average usage, the
next largest tube size would be purchased (cost of wastage is included).