Cost-effectiveness of topical pharmacological, oral pharmacological, physical and combined treatments for acne vulgaris

Abstract

Background: Acne vulgaris is a common skin condition that may cause psychosocial distress. There is evidence that topical treatment combinations, chemical peels and photochemical therapy (combined blue/red light) are effective for mild-to-moderate acne, while topical treatment combinations, oral antibiotics combined with topical treatments, oral isotretinoin and photodynamic therapy are most effective for moderate-to-severe acne. Effective treatments have varying costs. The National Institute for Health and Care Excellence (NICE) in England considers cost-effectiveness when producing national clinical, public health and social care guidance.

Aim: To assess the cost-effectiveness of treatments for mild-to-moderate and moderate-to-severe acne to inform relevant NICE guidance.

Methods: A decision-analytical model compared costs and quality-adjusted life-years (QALYs) of effective topical pharmacological, oral pharmacological, physical and combined treatments for mild-to-moderate and moderate-to-severe acne, from the perspective of the National Health Service in England. Effectiveness data were derived from a network meta-analysis. Other model input parameters were based on published sources, supplemented by expert opinion.

Results: All of the assessed treatments were more cost-effective than treatment with placebo (general practitioner visits without active treatment). For mild-to-moderate acne, topical treatment combinations and photochemical therapy (combined blue/red light) were most cost-effective. For moderate-to-severe acne, topical treatment combinations, oral antibiotics combined with topical treatments, and oral isotretinoin were the most cost-effective. Results showed uncertainty, as reflected in the wide confidence intervals around mean treatment rankings.

Conclusion: A range of treatments are cost-effective for the management of acne. Well-conducted studies are needed to examine the long-term clinical efficacy and cost-effectiveness of the full range of acne treatments.

Figure 1

Schematic diagram of the economic model structure for people with mild‐to‐moderate and people with moderate‐to‐severe acne vulgaris. Chemical peels were assessed only in people with mild‐to‐moderate acne. Oral isotretinoin was assessed only in people with moderate‐to‐severe acne.

Figure 2

Cost‐effectiveness planes. Results for 1000 people with acne vulgaris. In each graph, the points for each treatment show its incremental quality‐adjusted life years (QALYs) (horizontal axis) and costs (vertical axis) vs. treatment with placebo, which is placed at the origin. The slope of the dotted line indicates the National Institute for Health and Care Excellence lower cost‐effectiveness threshold of £20 000/QALY. Moving towards the right of the horizontal axis, treatments result in more QALYs. For both acne severity levels, all treatments produce more QALYs compared with treatment with placebo. Moving towards the top of the vertical axis, treatments become more costly. For both acne severity levels, all treatments are more costly than treatment with placebo, with the exception of BPO in mild‐to‐moderate acne, and with the exception of BPO, topical clindamycin, combined topical tretinoin with clindamycin, oral lymecycline, and azelaic acid combined with oral lymecycline in moderate‐to‐severe acne. In all three graphs, treatments lie on the right side of the dotted line, suggesting that in all three analyses all assessed treatments are cost‐effective compared with treatment with placebo.

Figure 3

Cost‐effectiveness acceptability frontier. Each graph shows the most cost‐effective treatment of each analysis, over a range of values of willingness to pay for a quality‐adjusted life year (QALY), which was varied between £0 and £40 000 per QALY (horizontal axis) and the probability that this treatment is the most cost‐effective of those assessed, reflecting the uncertainty in the results (vertical axis).