In the current economic climate, it is important to justify the cost of treatments used in dermatology, particularly where cheaper alternatives exist.
The purpose of this study is to determine which treatment modality commonly used for Bowen's disease (BD) is associated with the lowest cost to the National Health Service in England. A cost-minimization analysis was used to compare the following six treatments for Bowen's disease: cryotherapy, curettage and cautery, excision, laser ablation, photodynamic therapy, and 5-fluorouracil. These are all known to have similar recurrence rates. Information regarding use of these treatment modalities was extracted from a literature review. Costs were determined from published data, average wholesale prices of medications, staff salary pay scales, and health economics departments. The results show that, if treatment is indeed undertaken, a single lesion of Bowen's disease is most cheaply treated by curettage or excision biopsy under local anesthetic, and most expensively treated by photodynamic therapy. The usefulness of this information has to be taken in the context of the study design, outcome measurements, and base assumptions. Valid costing studies such as this, in conjunction with evidence of effectiveness and safety, can provide guidance for resource allocation and treatment decisions.
JDD Article Evaluation
To curette, or not to curette? It has been shown that curettage of lesions of BD is associated with a significantly shorter healing time, less pain, fewer complications and a lower recurrence rate when compared with cryotherapy. In terms of cost effectiveness curettage is faster and cheaper than excision, but the recurrence is higher for curettage. Of note, recurrence with cryosurgery is 34% compared to 5% with excision, and curettage in between. All in all, curettage is faster and cheaper than excision and more effective than cryosurgery, but excision has the lowest recurrence and is still the preferred modality by the editor.
1. Ramrakha-Jones VS, Herd RM. Treating Bowen's disease: a cost-minimization study. Br J Dermatol 2003 Jun; 148(6):1167-72.
2. Thestrup-Pedersen K, Ravnborg L, Reymann E Morbus Bowen: a description of the disease in 617 patients. Acta Derm Venereol 1988; 68(3):236-9.
Ramrakha-Jones VS, Herd RM. Br J Dermarol 2003 Jun; 148(6):1167-72.
COPYRIGHT 2003 Journal of Drugs in Dermatology
COPYRIGHT 2003 Gale Group
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