EVALUATION OF TREATMENT EFFICACY AND COST-EFFECTIVENESS FOR WARTS IN PATIENTS WITH ADVANCED MALIGNANCIES
DOI:
https://doi.org/10.48047/jbxkjh15Keywords:
Warts, Human Papillomavirus (HPV), Cost-Effectiveness, Cryotherapy, Topical Imiquimod, Surgical Excision, Remission.Abstract
This research paper was to compare the clinical effectiveness and cost-effectiveness of different treatments of warts in 300 patients, considering the complete remission (CR) rates and the cost involved. Human papillomavirus (HPV) is the main cause of warts that can be seen in people of all ages and treated because of its painful and unattractive appearance. The methods of treatment evaluated in the study included four treatments: cryotherapy, topical imiquimod, surgical excision and combinations (cryotherapy and topical imiquimod). Age, gender, performance status, cancer stage (with cancer patients) and previous treatment history were identified as the baseline data. The outcomes indicated that 60 percent of patients attained CR with original warts and 73.3 percent with warts of any kind. The most prevalent modality was cryotherapy (50%), then topical imiquimod (38.9%), and surgical excision (11.1). The recurrence rates of original warts and warts in general were 22.2 and 22.7 respectively. The overall average cost per patient was 3250 that comprised both the direct and indirect cost. The economic model showed that combined therapy was the most affordable of the treatment generated and its cost was 2,450/CR. Cryotherapy and topical imiquimod were both effective and cost-effective and surgical excision was the least cost-effective intervention. These results indicate that cryotherapy and topical imiquimod are more appropriate because of their effectiveness and costs, especially when limited resources are used, and combined therapy may be the most appropriate with respect to the success of therapy and costs.
Downloads
References
PHLS, DHSS&PS and the Scottish ISD(D)5 Collaborative Group. Sexually transmitted infections in the UK: new episodes seen at genitourinary medicine clinics, 1995 to 2000. London: Public Health Laboratory Service, 2001.
Persson G, Andersson K, Krantz I. Symptomatic genital papillomavirus infection in a community B incidence and clinical picture. Acta Obstet Gynecol Scand 1996;75:287–90.
Gross G, Ikenberg H, Gissmann L, et al. Papillomavirus infection of the anogenital region: correlation between histology, clinical picture and virus type. J Invest Dermatol 1985;85:147–52.
Beutner KR, Ferenczy A. Therapeutic approaches to genital warts. Am J Med 1997;102:28–37.
Centers for Disease Control, Division of STD Prevention. Sexually transmitted disease surveillance 1995. US Department of Health Services, Public Health Service. Atlanta: Centers for Disease Control and Prevention, September 1996.
Kaplan IW. Condylomata acuminata. New Orleans Med Surg J 1942;94:388–90.
Von Krogh G, Maibach HI. Cutaneous cytodestructive potency of lignans. I. A comparative evaluation of influence on epidermal and dermal DNA synthesis and on dermal microcirculation in the hairless mouse. Arch Dermatol Res 1982;274:9–20.
Fraser PA, Lacey CJN, Maw RD. Motion: podophyllotoxin is superior to podophyllin in the treatment of genital warts. J Europ Acad Dermatol Venereol 1993;2:328–34.
Longstaff E, von Krogh G. Condyloma eradication: self-therapy with 0.15–0.5% podophyllotoxin versus 20–25% podophyllin preparations B an integrated safety assessment. J Regulatory Toxicol Pharmacol 2001:33:177–237.
Von Krogh G. Penile condylomata acuminata: an experimental model for evaluation of topical self-treatment with 0.5%-1% ethanolic preparations of podophyllotoxin for 3 days. Sex Transm Dis 1981;8:179–84.
Strand A, Brinkeborn RM, Siboulet A. Topical treatment of genital warts in men, an open study of podophyllotoxin cream compared with solution. Genitourin Med 1995;71:387–90.
Claesson U, Lassus A, Happonen H, et al. Topical treatment of venereal warts: a comparative open study of popdophyllotoxin cream versus solution. Int J STD AIDS 1996;7:429–34.
Tyring S, Edwards L, Cherry LK, et al. Safety and efficacy of 0.5% podofilox gel in the treatment of anogenital warts. Arch Dermatol 1998;134:33–8.
Lassus A. Comparison of podophyllotoxin and podophyllin in the treatment of genital warts. Lancet 1987;ii:512–3
Edwards A, Atma-Ram A, Thin RN. Podophyllotoxin 0.5% v podophyllin 20% to treat penile warts. Genitourin Med 1988;64:63–5.
Kinghorn GR, McMillan A, Mulcahy FM, et al. An open, comparative study of the efficacy of 0.5% podophyllotoxin lotion and 25% podophyllin solution in the treatment of condyloma acuminata in males and females. Int J STD AIDS 1993;4:194–9.
Hellberg D, Svarrer T, Nilsson S, et al. Self-treatment of female external genital warts with 0.5% podophyllotoxin cream (Condyline) vs weekly applications of 20% podophyllin solution. Int J STD AIDS 1995;6:257–61.
Central Statistical Office. Annual abstract of statistics 1999, no 135. London: The Stationery Office, 1999.
Maw RD, Reitano M, Roy M. An international survey of patients with genital warts: perceptions regarding treatment and impact on lifestyle. Int J STD AIDS 1998;9:571–8.
Drummond MF, O’Brien B, Stoddart GL, et al. Methods for the economic evaluation of health care programmes. Oxford: Oxford Medical Publications, 1997.
Drummond M. Cost-of-illness studies. A major headache? PharmacoEconomics 1992;2:1–4.
Koopmanschap MA, Rutten FFH. Indirect costs in economic studies. Confronting the confusion. PharmacoEconomics 1993;4:446–54.
Mohanty KC. The cost-effectiveness of treatment of genital warts with podophyllotoxin. Int J STD AIDS 1994;5:253–6.
Strauss MJ, Khanna V, Koenig JD, et al. The cost of treating genital warts. Int J Dermatol 1996;35:340–8.
Alam M, Stiller M. Direct medical costs for surgical and medical treatment of condylomata acuminata. Arch Dermatol 2001;137:337–41.
Drummond M, Davies L. Economic analysis alongside clinical trials. Revisiting the methodological issues. Int J Technol Assess Health Care 1991;7:561–73.
Centers for Disease Control and Prevention. 1998 Guidelines for treatment of sexually transmitted diseases. MMWR 1998;47(No RR-1):88–95.
Coleman N, Birley HD, Renton AM, et al. Immunological events in regressing genital warts. Am J Clin Pathol 1994;102:768–74.
Downloads
Published
Issue
Section
License
This work is licensed under a Creative Commons Attribution 4.0 International License.
You are free to:
- Share — copy and redistribute the material in any medium or format for any purpose, even commercially.
- Adapt — remix, transform, and build upon the material for any purpose, even commercially.
- The licensor cannot revoke these freedoms as long as you follow the license terms.
Under the following terms:
- Attribution — You must give appropriate credit , provide a link to the license, and indicate if changes were made . You may do so in any reasonable manner, but not in any way that suggests the licensor endorses you or your use.
- No additional restrictions — You may not apply legal terms or technological measures that legally restrict others from doing anything the license permits.
Notices:
You do not have to comply with the license for elements of the material in the public domain or where your use is permitted by an applicable exception or limitation .
No warranties are given. The license may not give you all of the permissions necessary for your intended use. For example, other rights such as publicity, privacy, or moral rights may limit how you use the material.
