Total quality management in dermato-mycology in Germany.

Mycoses of the skin are extremely frequent. The clinical presentation often resembles the one of other frequent inflammatory skin diseases not caused by fungi. Adequate diagnostics are critical for the establishment of proper treatment. A total quality management system has been devised in Germany during the last 5 years. There are several guidelines addressing various aspects of the management of various types of disease as well as structure quality of laboratory diagnostics. Continuous medical education and so-called ring trials are major aspects of implementation.

Pharmacoeconomic analysis of topical treatments for tinea infections.

BACKGROUND: A payor-perspective economic analysis of the topical creams ciclopirox, clotrimazole, ketoconazole, miconazole, and terbinafine (TER) used to treat dermatophytosis has been made. This pharmacoeconomic evaluation was conducted in Austria, Germany, and Switzerland. METHODS: A four-phase approach was used. Phase 1: experts were assembled to identify the standard approach for management of fungal infections and a decision tree was constructed to model the process. Phase 2: meta-analysis was used to determine success, failure, and relapse rates. Phase 3: economic analyses performed included cost of regimen, total expected cost, and cost-effectiveness. Phase 4: sensitivity analyses (robustness analysis) were also executed to determine the validity of the assumptions. RESULTS: In the total expected cost analysis, TER demonstrated the lowest overall cost of treating patients. Terbinafine also provided the highest number of disease-free days during the analytic time horizon and, consequently, the lowest cost per disease-free day. Sensitivity analyses suggest that TER is the most cost-effective topical product for treating dermatophytosis in Austria, Germany, and Switzerland. CONCLUSIONS: All analytic scenarios suggest that TER therapy demonstrates lower expected costs and generates more DFDs when compared with the fungistatic topical therapies included in this pharmacoeconomic analysis. Terbinafine is expected to be the most cost-effective choice in Austria, Germany, and Switzerland for treatment of dermatophytosis minor.

Pharmacoeconomic analysis of topical treatments for tinea infections.

The purpose of this study was to perform a government-perspective economic analysis of the most widely used topical creams [namely, ciclopirox (CIC), clotrimazole (CLO), ketoconazole (KET), miconazole (MIC), and terbinafine (TER)], for the treatment of 2 types of dermatophyte skin infections: dermatophytosis major (excluding onychomycosis) and dermatophytosis minor. A 3-phase approach was used. In phase I, experts were assembled to identify the standard approach for management of fungal infections and a decision tree was constructed to model the process; in phase II, meta-analysis was used to determine success, failure, and relapse rates; and in phase III, economic analyses were performed including cost of regimen, total expected cost and cost-effectiveness analysis. Sensitivity analyses (robustness analyses) were also performed in phase III. It was found that while TER was successful following 1 week of administration for minor infections and after 2 weeks for major infections, duration of drug treatment was usually twice that time. Other comparators (CIC, CLO, KET and MIC) took 4 weeks to achieve a successful outcome. In addition, an extra 2 weeks were often needed to clear both types of infections because the comparators are fungistatic, whereas TER is fungicidal. In the total expected cost analysis, TER had the lowest overall cost of treating patients for both infection categories. It was also responsible for the highest number of disease-free days and, consequently, the lowest cost per disease-free day. Sensitivity analyses confirmed that TER was the most cost-effective topical agent for treating dermatophytosis major (excluding onychomycosis) and dermatophytosis minor.

Costs of therapy for dermatophyte infections.

The price of drugs is an important consideration in the determination of the therapy's cost effectiveness. In this article the cost of antifungal drugs to several pharmacies (from a wholesaler) is calculated for topical and oral drug regimens to treat three hypothetical patients with dermatophyte infections. Drug costs to pharmacies for the topical treatment of tinea varied greatly--more than 14-fold (for 4-week courses, from $11.14 for miconazole to $156.72 for terbinafine). Costs to pharmacies of oral drugs for tinea also varied considerably, although the degree of difference depended on the regimens used for fluconazole and itraconazole, for which optimal dosages and durations of therapy have not been determined and for which this use is not approved by the Food and Drug Administration. Given the frequency of these infections and the importance of outcomes in addition to clinical cure (such as prevention of relapse), this difference highlights the need for formal studies to compare drug effectiveness in combination with cost.