Comparison of safety, efficacy, and cost effectiveness of benzyl benzoate, permethrin, and ivermectin in patients of scabies

Abstract

Objective: To compare three treatment modalities in scabies for safety, efficacy, and economy in a local population of Nagpur.

Materials and methods: This was a prospective, randomized, comparative clinical trial conducted in 103 participants, randomly allocated to three groups. First group received benzyl benzoate (BB) 25% lotion, second group received permethrin 5% cream, whereas third group received tablet ivermectin 200 mug/kg as a single dose. The participants were recalled after one week for follow-up evaluation. If there were no signs of cure, the same intervention was repeated. The participants were followed up for two weeks for cure rate, adverse drug reaction (ADR) monitoring, and postintervention observation. The follow-up was stopped after two weeks.

Statistics: Fischer's exact test using Graph pad Instat v 3.05.

Results: Ivermectin showed 100% cure rate after two weeks of treatment. Permethrin decreased pruritus by 76% at the end of one week and had significantly better cure rate than ivermectin. At the end of two weeks treatment, this finding was reversed, that is, cure rate in ivermectin group was 100%. For cost-effectiveness analysis, treatment regimens were formulated hypothetically for comparison from Markov population tree for decision analysis. It was found that BB and ivermectin each consecutively for two weeks were most cost effective regimens giving complete cure in four weeks, while ivermectin was the fastest regimen giving the same results in two weeks.

Conclusion: Benzyl benzoate as first line intervention and ivermectin in the remaining gave best cost-effective results in the study patients of scabies.

Keywords: Efficacy; economic analysis; scabies; treatment.

Figure 1

Cost-effectiveness of benzyl benzoate and ivermectin as compared to permethrin ΔC - incremental cost, ΔE - incremental efficacy, Red dot - cost effectiveness of ivermectin (ΔC = − INR57.08; ΔE = −4.43), Blue dot - cost effectiveness of benzyl benzoate (ΔC = −INR34.61; ΔE = 3.57)

Figure 2

Markov model of decision analysis for cost effectivness of different regimens in scabies benzyl benzoate, P - permethrin, I - ivermectin treatment, Red line - not cured, Black line - cured, Green dotted line - tracing lines The “Markov population model of decision analysis” was prepared using our clinical data for efficacy of each intervention at one and two weeks. Figures in the box on the right side show cost of treatment. The numbers in subscript denote duration of treatment in weeks. The tree has been designed considering 10,000 patient recruitments in each branch for easy analysis. Numbers above the horizontal arrow lines show number of patients in that branch.