To freeze or not to freeze: a cost-effectiveness analysis of wart treatment

• Published in: British journal of dermatology (1951) Vol. 156; no. 4; pp. 687 - 692
• Main Authors: Keogh-Brown, M.R., Fordham, R.J., Thomas, K.S., Bachmann, M.O., Holland, R.C., Avery, A.J., Armstrong, S.J., Chalmers, J.R., Howe, A., Rodgers, S., Williams, H.C., Harvey, I.
• Format: Journal Article
• Language: English
• Published: Oxford, UK Blackwell Publishing Ltd 01.04.2007; Blackwell
• Subjects: Anti-Infective Agents - therapeutic use; Biological and medical sciences; Cost-Benefit Analysis; cryotherapy; Cryotherapy - economics; decision analysis; Dermatologic Agents - economics; Dermatologic Agents - therapeutic use; Dermatology; Human viral diseases; Humans; Infectious diseases; Markov model; Medical sciences; salicylic acid; Salicylic Acid - economics; Salicylic Acid - therapeutic use; Treatment Outcome; Viral diseases; Viral diseases with cutaneous or mucosal lesions and viral diseases of the eye; Warts - therapy; United Kingdom; Europe; Prostaglandin-endoperoxide synthase; Skin disease; Wart; decision analysis; Local administration; Salicylates; Antirheumatic agent; Public health; Cost efficiency analysis; Salicylic acid; Enzyme; Dermatology; Enzyme inhibitor; Markov model; Infection; Non steroidal antiinflammatory agent; Analgesic; Treatment; Viral disease; Health economy; Antipyretic; Oxidoreductases; Cost analysis; Cryotherapy; Comparative study
• ISSN: 0007-0963; 1365-2133
• DOI: 10.1111/j.1365-2133.2007.07768.x

Summary Background  Several general practitioner (GP)‐prescribed and over‐the‐counter therapies for warts and verrucae are available. However, the cost‐effectiveness of these treatments is unknown. Objectives  To compare the cost‐effectiveness of different treatments for cutaneous warts. Methods  We designed a decision‐analytic Markov simulation model based on systematic review evidence to estimate the cost‐effectiveness of various treatments. The outcome measures studied are percentage of patients cured, cost of treatment and incremental cost‐effectiveness ratio for each treatment, compared with no treatment, after 18 weeks. Results  Duct tape was most cost‐effective but published evidence of its effectiveness is sparse. Salicylic acid was the most cost‐effective over‐the‐counter treatment commonly used. Cryotherapy administered by a GP was less cost‐effective than GP‐prescribed salicylic acid and less cost‐effective than cryotherapy administered by a nurse. Conclusions  Duct tape could be adopted as the primary treatment for cutaneous warts if its effectiveness is verified by further rigorous trials. Nurse‐administered cryotherapy is likely to be more cost‐effective than GP‐administered cryotherapy.