Cost-effectiveness of cryotherapy versus salicylic acid for the treatment of plantar warts: economic evaluation alongside a randomised controlled trial (EVerT trial)

Abstract

Background: Plantar warts (verrucae) are extremely common. Although many will spontaneously disappear without treatment, treatment may be sought for a variety of reasons such as discomfort. There are a number of different treatments for cutaneous warts, with salicylic acid and cryotherapy using liquid nitrogen being two of the most common forms of treatment. To date, no full economic evaluation of either salicylic acid or cryotherapy has been conducted based on the use of primary data in a pragmatic setting. This paper describes the costeffectiveness analysis which was conducted alongside a pragmatic multicentre, randomised trial evaluating the clinical effectiveness of cryotherapy versus 50% salicylic acid of the treatment of plantar warts. Methods: A cost-effectiveness analysis was undertaken alongside a pragmatic multicentre, randomised controlled trial assessing the clinical effectiveness of 50% salicylic acid and cryotherapy using liquid nitrogen at 12 weeks after randomisation of patients. Cost-effectiveness outcomes were expressed as the additional cost required to completely cure the plantar warts of one additional patient. A NHS perspective was taken for the analysis. Results: Cryotherapy costs on average £101.17 (bias corrected and accelerated (BCA) 95% CI: 85.09-117.26) more per participant over the 12 week time-frame, while there is no additional benefit, in terms of proportion of patients healed compared with salicylic acid. Conclusions: Cryotherapy is more costly and no more effective than salicylic acid.Trial registration Current Controlled Trials ISRCTN18994246 [controlled-trials.com] and National Research Register N0484189151.

Evaluating the success of Nd: YAG laser ablation in the treatment of recalcitrant verruca plantaris and a cautionary note about local anaesthesia on the plantar aspect of the foot

“…Another method of physical destruction commonly used is cryotherapy. Despite not leaving scars, studies have shown that in some cases, cryotherapy is no more effective than the application of topical Salicylic Acid and is more expensive . The HPV virus has also been found to respond more to treatment with heat (hyperthermia) compared to cryotherapy – suggesting that laser ablation kills the virus more effectively .…”

A Retrospective Study of a Chinese Traditional Medicine YIKEER in the Treatment of Verruca Patients in Liaoning District

“…Topical agents such as salicylic acid and cantharidin may have beneficial effect on verruca vulgaris and verruca plantaris [21][22][23]. But these agents should not be used by patients themselves theoretically.…”

“…Another commonly used method of physical destruction is cryotherapy. Despite not leaving scars, cryotherapy is not more effective than topical salicylic acid in some cases [21][22][23]. Besides, these aggressive treatments often cause intolerable pain, hyperpigmentation, hypopigmentation, or occasionally allergic contact dermatitis [26,27].…”

Topical cidofovir for plantar warts

“…As no controlled double‐blind clinical trials exist, there is no consensus about the most suitable concentration to use (generally 1–3%), its application scheme (1–2 times daily, with or without occlusion), or the optimal duration of treatment. Accordingly, further studies are required to define these factors .…”

“…The treatment of PW has involved several different modes, including ablative therapy and other options that modify the immune response . Cidofovir is a potent antiviral agent that inhibits the activity of DNA polymerase and that has been approved for the intravenous treatment of retinitis due to cytomegalovirus in immunosuppressed patients .…”