Better cost-effectiveness of amorolfine nail lacquer 5% once weekly application vs twice weekly application in the treatment of mild and moderate onychomycosis

Objective: To determine the most cost-effective dosage of amorolfine 5% nail lacquer for onychomycosis treatment in Spain using data from 2006. Material and method: We performed a comparative cost-effectiveness analysis from the perspective of social funding between once- or twice-weekly applications of amorolfine 5% nail lacquer in the treatment of mild or moderate onychomycosis. Results: When clinical improvement was taken as the efficacy measure, the most cost-effective dosage was onceweekly administration of amorolfine nail lacquer, with a social cost (including visits, diagnosis, and treatment) of 93 € for 6 months of treatment. The incremental cost-effectiveness ratio (ICER) which compared both strategies was 1,587 euros/eu (efficacy unit) for the whole model and was 5,606 euros/eu for the model that took only dermatophyte infections into account. Sensitivity analyses showed adequate robustness for both efficacy and the added cost of failure in both models. Conclusions: The better cost-effectiveness of the onceweekly application was mainly a consequence of the small difference in efficacy between the once- and twice-weekly applications, combined with the lower cost of the once-weekly application. Sensitivity analyses for the main variables confirmed the robustness of the results. Treatment with amorolfine 5% solution nail lacquer applied once weekly is more cost-effective than twice-weekly administration in the treatment of mild or moderate onychomycosis.