Pharmacological analysis of nail lacquer to treat onychomycosis in Spain

Introduction: For the topical treatment of onychomycosis three treatments, amorolfine, ciclopirox and tioconazole in nail lacquer solution are currently available in Spain. Until now, no pharmacoeconomic studies have been performed to determine which of these active principles in nail lacquer is the most costeffective for the treatment of mild onychomycosis. Objective: To determine the most cost-effective treatment for dermatophyte onychomycosis in Spain in 2004. Material and method: A cost-effectiveness study was performed from the financial perspective of the public health service of the different topical treatments in nail lacquer formulation (ciclopirox, amorolfine and tioconazole) for white superficial onychomycosis and/or mild distal onychomycosis. Monotherapeutic alternatives and the option of non-treatment were also analyzed. The therapeutic regimens consisted of recurrent cycles for a maximum of 30 months. This recurrence was analyzed in a cost-effectiveness study with Markov chains. Results: The most efficient alternative was monotherapy with ciclopirox at 8% in nail lacquer. Discussion: These results are due to the advantages presented by ciclopirox in price and clinical outcomes over the other treatments. Recurrence rates were similar. The robustness of the results was confirmed by a sensitivity analysis of the main variables. Conclusion: Ciclopirox nail lacquer solution 8% shows superior cost-effectiveness compared with amorolfine and tioconazole in nail lacquer solution for the treatment of onychomycosis.