A retrospective cost-effectiveness analysis of the treatment of onychomycosis in general practice

Humphrey, Tim; Cork, Michael J.; Haycox,

doi:10.1046/j.1365-2133.1998.02463.x

Cited by 14 publications

(5 citation statements)

References 6 publications

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“…The infection must be proven by microscopy or culture and confirmed by an approved pathology provider.’ This limits the use of affordable terbinafine to those with nail disease only, and obtaining it for remote Aboriginal patients via Section 100 prescription is often the only way rural general practitioners or district medical officers can obtain it for extensive skin disease. Overseas studies have shown that terbinafine is a cost‐effective treatment because of the shorter duration of therapy, particularly in treating onychomycosis 20,21 . The present study and also anecdotal reports from community members and medical practitioners show that terbinafine is an effective and acceptable treatment for tinea (in particular tinea corporis), which has the potential to turn around the perceptions of health staff and community members that tinea is a ‘normal’ condition for those living in remote Aboriginal communities.…”

Section: Discussionsupporting

confidence: 51%

Use of terbinafine for tinea in Australian Aboriginal communities in the Top End

et al. 2003

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Tinea of the skin and nails is a common problem in remote Aboriginal communities of the Top End of Australia. A retrospective study was performed on data collected from 104 patients from several indigenous communities. Worksheets were filled in by district medical officers and rural general practitioners, detailing the extent of the tinea. Patients were prescribed between 4 and 12 weeks of 250 mg daily oral terbinafine. Fifty-two patients were followed up, with 45 having a good response to treatment (87%) and with 22 of these patients having full clearance of tinea (42%). A prospective study with 44 subjects was performed. The extent of the tinea was documented and fungal scrapings/clippings were taken. Forty subjects were recruited and given oral terbinafine (2-12 weeks depending on skin/nail involvement) or topical terbinafine if oral treatment was contraindicated. Twenty-five of the 40 (63%) subjects were reviewed. Twenty-three (92%) subjects that were followed up improved clinically, with 8/25 (32%) clearing completely. Twenty (80%) of followed-up patients complied fully with treatment. Terbinafine was found to be a well-tolerated and effective treatment of tinea of the skin and nails.

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Section: Discussionsupporting

confidence: 51%

Use of terbinafine for tinea in Australian Aboriginal communities in the Top End

et al. 2003

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“…By calculating direct treatment costs (drugs, medical consultations, minor surgery, etc.) and mycological and clinical cure rates (based on the results of a previous multinational study), they found that terbinafine was the most cost‐effective option 4 . However this study also presented a flaw leading to an incorrect conclusion.…”

Section: General Retrospective Pharmacoeconomic Studiesmentioning

confidence: 82%

“…Humphrey et al . performed a retrospective analysis to compare the cost‐effectiveness of terbinafine, tioconazole, amorolfine and griseofulvin 4 . By calculating direct treatment costs (drugs, medical consultations, minor surgery, etc.)…”

Section: General Retrospective Pharmacoeconomic Studiesmentioning

confidence: 99%

“…performed a retrospective analysis to compare the cost-effectiveness of terbinafine, tioconazole, amorolfine and griseofulvin. 4 By calculating direct treatment costs (drugs, medical consultations, minor surgery, etc.) and mycological and clinical cure rates (based on the results of a previous multinational study), they found that terbinafine was the most costeffective option.…”

Section: General Retrospective Pharmacoeconomic Studiesmentioning

confidence: 99%

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Pharmacoeconomics – an aid to better decision‐making

Arenas-Guzman¹,

Tosti

Hay

et al. 2005

Acad Dermatol Venereol

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We discussed current pharmacoeconomic issues on the management of onychomycosis. Consensus was reached on the following issues: * Published pharmacoeconomic studies concerning onychomycosis are flawed. Future studies should be based on internationally validated principles and appropriate models. The fact that costs of different drugs, laboratory examinations and physician visits vary worldwide should be considered. Cost-benefit studies are required. * The National Institute for Clinical Excellence (NICE) recommendations are often considered in countries other than the UK, even when not adapted to the country in question. * Generic drugs might reduce costs, but this depends on their effectiveness (bioavailability). * Sampling requests affect the economic cost (dependent on methodology, which depends on country) and physicians often trust their instincts even when tests are repeatedly negative. * The cost of adverse event management is usually considered to be 10%; this may be too high for onychomycosis, as treatments are relatively safe without severe side-effects. * Probability of recurrence for each drug should be determined. * Need for disease severity standardization, definition of diagnostic criteria and successful treatment (mycological and clinical cure).

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“…The results have substantiated that allylamine-type drugs because of their higher bioavailability and persistent retention at the superficial fungal infection site, provide higher cure rates, lower relapse rates and shorter treatment regimens than the azoles. Table 3 illustrates applications and comparative cost effectiveness [35][36][37][38] for the leading topical antifungals used in tinea pedis. In summary, looking at the parameters like efficacy, safety profile, patient compliance, relapse rates and cost effectiveness, butenafine hydrochloride is a promising potential alternative topical antimycotic agent for the treatment of tinea pedis.…”

Section: Discussionmentioning

confidence: 99%

Butenafine hydrochloride: for the treatment of interdigital tinea pedis

Syed

Maibach

2000

Expert Opinion on Pharmacotherapy

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Butenafine, a derivative of benzylamine with potent fungicidal activity is a new generation of antimycotic compound that has shown to be extremely effective against experimentally-induced tinea pedis in the guinea-pig, a situation that resembles synergetic pathology similar to that of tinea pedis in humans. Butenafine, (N-4-tert-butylbenzyl-N-methyl-1-naphthalenemethyl-amine hydrochloride) with a chemical structure and mode of action similar to those of the allylamines, demonstrates superior fungicidal activity in vitro against dermatophytes and superior fungistatic activity toward Candida albicans that of naftifine and terbinafine. In vitro, pharmacodynamic data has shown that the geometric mean of minimum inhibitory concentration values for butenafine were comparatively lower than those of naftifine and clotrimazole against clinical isolates for many dermatophytes. It inhibits sterol synthesis by blocking the squalene epoxidation stage in fungi. In phramacokinetic assessments butenafine achieves and maintains high concentrations and long retention time in skin, with associated anti-inflammatory activity in vivo. In controlled clinical trials when applied topically, butenafine appears to be well tolerated with a subjective mild burning sensation at the application site. There were no withdrawals from the study. Butenafine is sparingly soluble in water but readily soluble in methanol, ethanol, dichloromethane and chloroform. If incorporated properly in semisolid topical preparations, with a balanced vehicle, butenafine hydrochloride potentially exhibits as a promising alternative antimycotic agent for the treatment of tinea pedis.

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A retrospective cost-effectiveness analysis of the treatment of onychomycosis in general practice

Cited by 14 publications

References 6 publications

Use of terbinafine for tinea in Australian Aboriginal communities in the Top End

Use of terbinafine for tinea in Australian Aboriginal communities in the Top End

Pharmacoeconomics – an aid to better decision‐making

Butenafine hydrochloride: for the treatment of interdigital tinea pedis

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