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Journal of the American Academy of Dermatology
Volume 48, n° 4
pages 553-563 (avril 2003)
Doi : 10.1067/mjd.2003.240
accepted : 5 August 2002
Cost-effectiveness analysis of tacrolimus ointment versus high-potency topical corticosteroids in adults with moderate to severe atopic dermatitis

Charles N. Ellis, MDa, Lynn A. Drake, MDb, Mary M. Prendergast, MBAc, William Abramovits, MDd, Mark Boguniewicz, MDe, C.Ralph Daniel, MDf, Mark Lebwohl, MDg, Amy S. Paller, MDh, Seth R. Stevens, MDi,*, Diane L. Whitaker-Worth, MDj, Kuo B. Tong, MSk
Ann Arbor, Michigan; Boston, Massachusetts; Deerfield and Chicago, Illinois; Dallas, Texas; Denver, Colorado; Jackson, Mississippi; New York, New York; Cleveland, Ohio; Farmington, Connecticut; and San Francisco, California 
From the Department of Dermatology, University of Michigan Medical School, Ann Arbora; Massachusetts General Hospital, Harvard Medical School, Bostonb; Fujisawa Healthcare Inc, Deerfieldc; Baylor University Medical Center and University of Texas Southwestern School of Medicine, Dallasd; National Jewish Medical and Research Center, Denvere; University of Mississippi, Jacksonf; The Mount Sinai School of Medicine of New York University, New Yorkg; Northwestern University Medical School, Chicagoh; University Hospitals of Cleveland, Case Western Reserve Universityi; University of Connecticut Health Center, Farmingtonj; and Quorum Consulting Inc, San Francisco.k 


Background: Few cost-effectiveness analyses have been conducted on topical therapies for atopic dermatitis. Objective: We sought to compare cost-effectiveness of high-potency topical corticosteroids (HPTCs) and tacrolimus ointment for the treatment of moderate to severe atopic dermatitis for patients who are not responsive to or not well controlled with mid-potency topical corticosteroids. Methods: A Markov model represented the cyclic nature of atopic dermatitis. Clinical outcomes were derived from published literature. “Efficacy” was defined as disease-controlled days on which patients experienced a greater than 75% improvement in their disease. Resource use and changes in management were on the basis of opinions of a physician panel; secondary treatment was an oral antibiotic with topical corticosteroids. Sensitivity analyses were conducted for all variables. Results: The model was sensitive to duration of continuous treatment with HPTCs. HPTCs, when limited to 2-week treatment cycles, were associated with the highest total costs ($1682 per year) and the least efficacy (185 disease-controlled days). HPTCs in 4-week treatment intervals and tacrolimus ointment were similar in total costs and efficacy ($1317 vs $1323 for 194 vs 190 disease-controlled days, respectively). Although primary drug costs were higher for patients treated with tacrolimus ointment, patients treated with regimens of HPTCs incurred higher secondary drug costs. Conclusion: In the base case analyses, tacrolimus ointment was more cost-effective than HPTCs administered in 2-week treatment cycles, and similar in cost-effectiveness to 4-week cycles of HPTCs. (J Am Acad Dermatol 2003;48:553-63.)

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Abbreviations : AD, AWP, DCDs, DFDs, HPTCs, QALYs

 Supported by Fujisawa Healthcare Inc.
 Disclosure: All physician authors were compensated for their time serving on the advisory board for this work. Ms Prendergast is an employee of Fujisawa Healthcare Inc. Dr Ellis and Mr Tong are consultants to Fujisawa Healthcare Inc. Drs Ellis, Drake, Abramovits, Boguniewicz, Daniel, Lebwohl, and Whitaker-Worth have been investigators for clinical trials sponsored by Fujisawa Healthcare Inc. Drs Drake, Abramovits, Boguniewicz, Stevens, and Whitaker-Worth have been compensated by Fujisawa Healthcare Inc for speaking engagements. Dr Stevens has received a research grant from Fujisawa Pharmaceutical Co Ltd.
 Reprint requests: Charles N. Ellis, MD, Department of Dermatology, University of Michigan Medical School, 1500 E Medical Center Dr, Ann Arbor, MI 48109-0314.
 * Dr Stevens is currently with Amgen, Inc, Thousand Oaks, Calif.
 0190-9622/2003/$30.00 + 0

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