Table.
Cost effectiveness of alternative topical treatments for fungal skin infections of foot. Costs are in £
| NHS cost
|
Marginal NHS cost
|
||||||
|---|---|---|---|---|---|---|---|
| Comparison (No of trials) | % Pooled estimate of difference in cure rate (95% CI) | Retail price | Excluding GP time (unless stated) | Including GP time | OTC cost per cure (95% CI) | Per cure excluding GP time (95% CI) | Per cure including GP time (95% CI) |
| Allylamines v placebo (12 trials) | 55.6 (41.0 to 70.2) | Not OTC | 4.86 | 4.86+9.00=13.86 | Not OTC | 8.74 (6.92 to 11.85) | 24.93 (19.74 to 33.80) |
| Azoles v placebo (17 trials) | 37.6 (25.3 to 49.9) | 3.89 | 1.95 | 1.95+9.00=10.95 | 10.34 (7.80 to 15.38) | 5.19 (3.91 to 7.71) | 29.12 (21.94 to 43.28) |
| Allylamines v azoles (12 trials) | 7.9 (0.01 to 16.3) | If patient is consulting GP: 2.91−0.071*× 9.00†=2.27 If patient is consulting podiatrist: 11.91−0.071*× 9.00†=11.27 | Not OTC | 28.73‡ (lower bound 13.92; no upper bound) | 143§ (lower bound 69.14; no upper bound) | ||
| Undecenoic acid v placebo (4 trials) | 46.1 (31.6 to 60.6) | 1.89 | 1.89 | 1.89+9.00=10.89 | 4.10 (3.12 to 5.98) | 4.10 (3.12 to 5.98) | 23.62 (17.97 to 34.46) |
| Tolnaftate v placebo (3 trials) | 37.6 (2.6 to 72.5) | 1.83 | 1.83 | 1.83+9.00=10.83 | 4.87 (2.52 to 69.58) | 4.87 (2.52 to 69.58) | 28.80 (14.94 to 411) |
OTC=over the counter; GP=general practitioner.
*
Since allylamines cure 7.9% more infections than azoles on average, it is assumed that initial treatment with them will reduce consultations with GP by 7.9%.
†
Average cost of consultation with GP in his or her surgery is £9.00.w118
‡
When GP is considering during consultation initiated by patient or podiatrist whether to prescribe terbinafine or clotrimazole as first treatment.
§
When podiatrist is considering referring patient to GP for treatment with terbinafine rather than providing clotrimazole.