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Cost of Treatment for Onychomycosis

Data from a 9-Month Observational Study

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Abstract

Objectives: To estimate component and total costs of treatment and to examine differences in cost and cost effectiveness between oral antifungal medication and local therapy for patients with toenail onychomycosis.

Design: Prospective, observational study of patients with onychomycosis who visited dermatologists and podiatrists in the US. Physicians provided data on clinical management, disease severity, nail improvement and resource utilisation. Patients completed questionnaires on resource utilisation and symptoms at baseline, 4 and 9 months. To estimate costs, reported utilisation was multiplied by unit costs expressed in 1997 US dollars ($US) and derived in 2 ways: first, using Medicare fees; and second, using standard physician fees.

Results: After adjustment for key demographic and clinical variables, participants receiving oral medication had higher total costs based on standard fees ($US794 vs $US575) and medication costs ($US564 vs $US109), lower procedure costs ($US0 vs $US122) and physician visit costs ($US200 vs $US330), and greater clinical effectiveness as measured by global improvement rating (86 vs 35%) and Toenail Symptom Index (94 vs 49%). For participants receiving oral medication, 90% of total costs were incurred during the first 4 months of follow-up, whereas for those receiving local therapy, costs were more evenly distributed throughout the study period. Incremental cost-effectiveness analysis showed $US304 to $US491 per additional case improved with oral medication over a 9-month timeframe. Extrapolation of these results using 2 time-points (months 4 and 9) suggested that cost equivalence would be reached 17 to 21 months following the initiation of treatment.

Conclusions: During 9 months of follow-up in patients with toenail onychomycosis, the use of oral antifungal medication resulted in superior patient outcomes, but at higher total cost compared with local therapy.

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Acknowledgements

The authors gratefully acknowledge the assistance of Julie Weir with manuscript preparation and Stefanie Silva with statistical analysis.

Funding from Novartis Pharmaceuticals Corporation, East Hanover, New Jersey, USA, supported this research.

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Authors and Affiliations

  1. Eureka Research, San Francisco, California, USA

    David M. Stier

  2. The Lewin Group, 490 Second Street, Suite 201, San Francisco, CA, 94107, USA

    David M. Stier, Curt Henke,  Warren H. Schonfeld & Jeanette Broering

  3. Novartis Pharmaceuticals Corporation, East Hanover, New Jersey, USA

    Jeff Schein & Joe Doyle

  4. Urology Outcomes Group, University of California at San Francisco, San Francisco, California, USA

    Jeanette Broering

Authors
  1. David M. Stier
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  2. Curt Henke
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  3. Jeff Schein
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  4. Joe Doyle
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  5. Warren H. Schonfeld
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  6. Jeanette Broering
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Correspondence to Warren H. Schonfeld.

Additional information

Dr Henke died before the completion of this article. His contribution is gratefully acknowledged.

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Stier, D.M., Henke, C., Schein, J. et al. Cost of Treatment for Onychomycosis. Pharmacoeconomics 19, 267–279 (2001). https://doi.org/10.2165/00019053-200119030-00005

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