Healthcare reform demands cost-effectiveness

Dermatologists can provide value in the era of healthcare reform by realistically gauging the cost-effectiveness of many treatment strategies, according to an expert who spoke at the 71^st annual meeting of the American Academy of Dermatology in Miami Beach, Fla.

Regarding topical dapsone for acne, said Kevin Kia, M.D., pivotal trials of this product showed average reductions of 32 percent in noninflammatory lesions and 48 percent in inflammatory lesions at three months (Draelos ZD, Carter E, Maloney JM, et al. J Am Acad Dermatol. 2007;56(3):439.e1-e10).

"So why did the FDA (Food and Drug Administration) warn Allergan that it needed to stop (marketing) these numbers?" said Dr. Kia, clinical assistant professor of dermatology at the University of Texas Southwestern, Dallas.

The warning came because after two weeks, the drug achieved a 24 percent reduction in inflammatory lesions, versus 22 percent for vehicle.

"At three months," Dr. Kia said, "that 48 percent reduction was only 6 percent higher than vehicle. But we're buying it. And the cost per prescription is $350, versus $4 for the vehicle."

Regarding chronic idiopathic urticaria (CIU), "When I was a resident, I read in a textbook that if you have patients who are euthyroid or hypothyroid, but have thyroid antibodies, give them low-dose Synthroid (levothyroxine sodium, Abbott) and their urticaria will get better."

In a retrospective study involving 749 patients with ICU and autoimmune thyroiditis, investigators found 44 hypothyroid patients, all of whose hives improved with thyroid supplementation (Majen E, Mishal J. Int J Dermatol. 2012. 51:94-97). But Dr. Kia said that a control group of euthyroid patients with CIU who were not supplemented improved at the same rate.

Regarding CIU, "We have battery of tests, but no evidence saying we should be testing for anything" routinely.