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

Economic analyses were conducted in 2 stages. The first analysis considered each treatment separately in choosing to treat melasma compared to not treating, using a ratio of cost per primary success (complete clearing of melasma). This ratio can be considered as an incremental cost-effectiveness ratio assuming that without treatment no cost would be incurred for the melasma (beyond the standard use of sun-block and moisturizer), and no cases would show spontaneous clearing, which are reasonable assumptions in this clinical indication. The second analysis compared the 2 active treatments using the conventional ratio of the incremental cost for use of TCT to the additional chance of primary success.

Treatment of melasma is important for many patients, and other aspects of treatment success should be considered beyond clinical outcome from the physician's perspective. Although patient reported outcomes were not collected in this trial, melasma is associated with effects on patient quality of life and effective treatment of melasma is strongly related to improvements in these aspects. Impacts of melasma have been shown in domains of patient social life, recreation and leisure, and emotional well-being when using a validated quality of life scale. (14) A study of 1,290 patients with moderate to severe melasma treated with the TCT for up to 8 weeks showed significant improvements in the response to quality of life items, whereby 52 to 81% of patients indicated that they felt less embarrassed, more attractive and younger, used fewer cosmetics, and made less effort to hide their skin. (30)

Economic considerations are increasingly important in treatment choice, and an economic evaluation comparing costs and clinical effects can be useful to assist in the treatment decision. Per gram cost of medication is by itself a poor indicator for comparing costs of different dermatological treatments. (31) For TCT, price per gram is higher in every country, except the US, but the cost per primary success was at least 22% less than for HQ.

TCT provides a much more effective treatment for melasma with a 6 times greater likelihood of complete clearing within an 8-week period, and an excellent safety profile compared to HQ. TCT also has a substantial convenience advantage; since careful application to only the hyperpigmented areas is important for obtaining an even skin tone, an additional advantage of TCT cream is the convenience of once-daily application compared to the twice-daily application required for HQ. This should improve adherence to treatment.

Conclusion

When choosing to treat melasma, TCT provides higher effectiveness and a lower cost per case of complete clearing of melasma than the use of hydroquinone 4% alone.

References

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2. Pandya AG, Guevara IL. Disorders of Hyperpigmentation. Dermatologic Clinics. 2000;18:91-98.

3. Sanchez NP, Pathak MA, Sato S, Fitzpatrick TB, Sanchez JL, Mihm NC. Melasma: a clinical, light microscopic ultrastructural, and immunofluorescence study. J Am Acad Dermatol. 1981;4:698-710.