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

Sensitivity of results to varying quantity used per patient was assessed using the upper 95% CI of the average usage of TCT found in the trial (24.8 g). Results similar to the base case were found. In the US, TCT remained dominant and in other countries it still had a lower cost per primary success than HQ or compared to not treating (Table 3).

For the last sensitivity analysis, bleaching treatment cost was estimated for the required number of tubes of the 2 therapies including wastage (Table 3). In all countries, under this scenario TCT had a lower cost per primary success than HQ when compared to not treating. Moreover, the cost per primary success compared to not treating was worsened for HQ in countries where HQ was sold in a 30-g tubes (US, Brazil, Argentina) since for the average usage observed in the trial there was increased wastage and hence increased cost.

Discussion

In recent years, there has been a rapid increase in the number of economic evaluations of medicines and medical treatments. Several pharmacoeconomic studies have been developed for dermatological conditions. For instance, in the treatment of onychomycosis, many studies have compared oral treatments, topical treatments, and combination therapy. (24) Cost-effectiveness studies have also been developed to assess psoriasis treatment. (25) These cost-effectiveness analyses have been conducted for topical treatments (26) as well as for biologic therapies. (27,28) Finally, a recent publication showed that combined multiple laser approach was a cost effective treatment for phacomatosis pigmentovascularis. (29) The current study is the first economic evaluation comparing 2 melasma treatments.

This study found that the chance of complete clearing of melasma by 8 weeks was 6 times higher with TCT applied once daily than with HQ, with both products showing excellent tolerability. (17) When a decision to treat or not was considered, TCT was found to have a lower cost per treatment success (complete clearing) than HQ for all countries. Comparing active treatments, TCT was the clear choice (dominant) in the US with lower cost and better effectiveness.

Factors that affected cost-effectiveness results included greatly increased effectiveness with TCT, the decreased amount of TCT cream used compared to HQ due to the once daily application, and the differences in the purchase price of treatment. In the US where the purchase prices are very similar for the 2 products, TCT use was dominant over HQ.

Results are quite robust to varying assumptions of the effectiveness and quantity of treatment used. Over the range of the 95% CI in effectiveness of TCT, TCT had lower cost per primary success in all cases. Comparing the active treatments, TCT remained dominant in the US and incremental cost-effectiveness ratios did not vary in direction from the base case analyses.

Several sensitivity analyses were also conducted by varying the key driver of cost, the price and amount of melasma treatment used. Considering the most sold HQ 4% agent in countries where this differed from the comparator used in the trial, the cost per primary success associated with a choice to treat using each agent remains lower for TCT than for HQ. If it was assumed that a larger amount of each product was used (based on the upper 95% CI of the amount used in the trial), similar results were found to those demonstrated in the base case. TCT had a cost per primary success lower than HQ in all countries and remained dominant in the US.