3种抗真菌药物治疗甲真菌病的成本-效果分析

目的探讨3种抗真菌药物治疗甲真菌病的经济成本。方法选择100例患者随机分为3组,分别给予氟康唑、特比萘芬、伊曲康唑治疗,运用药物经济学的成本-效果分析方法进行评价。结果治疗指甲真菌病所需药品成本分别是,氟康唑92．80元、特比萘芬474．88元、伊曲康唑564．48元;治疗趾甲癣真菌病所需药品成本分别是,氟康唑139．20元、特比萘芬682．64元、伊曲康唑846．72元。3种药物治疗甲真菌病的痊愈率分别是72．73％,78．12％,80．00％。结论国产氟康哇是治疗甲真菌病的较佳药物。     

3种抗真菌药治疗甲癣真菌病的成本-效果分析

目的:探讨3种抗真菌药治疗甲癣真菌患者的成本和效果.方法:将96例甲癣真菌患者随机分为3组,分别给予国产氟康唑、酮康唑、伊曲康唑治疗.运用药物经济学的成本-效果分析方法进行评价.结果:治疗指甲癣真菌病所需药品成本分别是:国产氟康唑252元、酮康唑398元、伊曲康唑741元;治疗趾指甲癣真菌病所需药品成本分别是:国产氟康唑378元、酮康唑598元、伊曲康唑1111元.远期治疗指甲癣真菌病的有效率分别是91%,75%,97%;趾指甲癣真菌病分别是91%,78%,94%.结论:根据药物经济学成本-效果分析,国产氟康唑是治疗甲真菌病的较佳药物.     

3种抗真菌药治疗甲真菌病的成本-效果比较

目的探讨不同抗真菌药治疗甲真菌病的经济效果.方法选择120例甲真菌病患者,随机分成A、B、C3组,分别给予伊曲康唑、特比萘芬、氟康唑口服治疗,运用药物经济学的成本-效果分析方法进行评价.结果 A、B、C 3组方案中治疗指甲真菌病/趾甲真菌病的成本-效果比分别为10.23/15.07,9.21/12.56,10.61/15.99;敏感度分析后分别为9.17/13.32、8.27/11.14、9.58/14.24.结论 B组方案为治疗甲真菌病的最经济有效方案.     

3种抗真菌药治疗甲真菌病药物经济学分析

目的对伊曲康唑、特比萘芬、氟康唑3种不同抗真菌药物治疗120例甲真菌病患者的成本效果分析。方法选择120例病例,随机分为3组,分别给予伊曲康唑、特比萘芬、氟康唑治疗,观察各组疗效并运用药物经济学方法进行分析。结果3种药物均有较好的抗真菌疗效,特比萘芬疗效优于伊曲康唑及氟康唑,伊曲康唑疗效优于氟康唑。平均成本-效果比分别为8.9,8.0,11.7。结论药物经济学分析结果为特比萘芬治疗甲真菌病最优。     

伊曲康唑与特比萘芬治疗甲真菌病的研究

目的比较伊曲康唑与特比萘芬治疗甲真菌病的临床疗效。方法取220例甲真菌病患者,随机分为2组,一组给予特比萘芬0.25g,qd,指甲真菌病组连服6周,趾甲真菌病或指甲真菌病合并趾甲真菌病组连服12周。另一组给予伊曲康唑0.2g,bid,连服1周,停药3周为1个冲击疗程,指甲真菌病组连服2个冲击疗程,趾甲真菌病或指甲真菌病合并趾甲真菌病组连服3个冲击疗程。结果指甲真菌病痊愈率和愈显率特比萘芬组为87.0%和95.7%,伊曲康唑组为73.9%和78.3%。趾甲真菌病或指甲真菌病合并趾甲真菌病痊愈率和愈显率特比萘芬组为87.5%和95.3%,伊曲康唑组为75.0%和82.8%。结论特比萘芬治疗甲真菌病疗效优于伊曲康唑(P<0.05)。     

3种抗真菌药治疗甲真菌病的成本-效果比较

目的　探讨不同抗真菌药治疗甲真菌病的经济效果。方法　选择 12 0例甲真菌病患者 ,随机分成A、B、C3组 ,分别给予伊曲康唑、特比萘芬、氟康唑口服治疗 ,运用药物经济学的成本 效果分析方法进行评价。结果　A、B、C 3组方案中治疗指甲真菌病 /趾甲真菌病的成本 效果比分别为 10 2 3/ 15 0 7,9 2 1/ 12 .5 6 ,10 6 1/ 15 99;敏感度分析后分别为 9.17/ 13 32、8 2 7/11 14、9 5 8/ 14 2 4。结论　B组方案为治疗甲真菌病的最经济有效方案     

3种抗真菌药治疗甲真菌病的成本—效果比较

目的：探讨不同抗真菌治疗甲真菌病的经济效果，方法：选择120例甲真菌病患者，随机分成A、B、C2组，分别给予伊曲康唑，特比萘芬、氟康唑口服治疗，运用药物经济学的成本－效果分析方法进行评价，结果：A、B、C3组方案中治疗指甲真菌病／趾甲真菌病的成本－效果比分析另为10．23／15．07、，9．21，9．21／12．56，10．61／15．99， 敏感度分析后分别为9．17／13．32、8．27／11．14、9．58／14．24。结论：B组方案治疗甲真菌病的最经济有效方案。     

两种方案治疗甲真菌病的成本-效果分析

目的:探讨比较伊曲康唑胶囊与特比萘芬片治疗甲真菌病的成本-效果.方法:将临床甲真菌病患者分为A、B两组,A组82例采用伊曲康唑胶囊口服治疗,B组79例采用特比萘芬片口服治疗,应用药物经济学成本-效果分析法进行评价.结果:伊曲康唑胶囊与特比萘芬片治疗指/趾甲真菌病的总有效率分别为89.02%(73/82)和91.14%(72/79);成本分别为1039.92元和1 659.6元;C/E分别为11.68、18.21;△C/△E为292.3.结论:伊曲康唑胶囊具有更合理成本-效果优势.     

伊曲康唑和特比萘芬序贯疗法治疗甲真菌病的成本-效果分析

目的:探讨不同药物治疗方案对甲真菌病的经济效果.方法:根据文献数据,对75例甲真菌病患者分别采用伊曲康唑和特比萘芬序贯治疗、伊曲康唑冲击治疗和特比萘芬连续治疗,运用药物经济学的成本-效果分析方法进行评价.结果:3组具有相似的临床疗效,但序贯疗法与其他治疗方案相比,明显降低了医疗费用,具有药物经济学意义.结论:伊曲康唑和特比萘芬序贯疗法是治疗甲真菌病的最佳治疗方案.     

3种给药方案治疗甲真菌病的临床疗效和安全性观察

目的研究氟康唑、伊曲康唑、氟康唑联合自制药醋治疗甲真菌病的临床疗效和安全性差异。方法氟康唑组69例,采用氟康唑周服给药法;伊曲康唑组71例,采用伊曲康唑间歇冲击给药法;氟康唑联合自制药醋组60例,周服氟康唑并每日局部外涂自制药醋。结果氟康唑组与伊曲康唑组总有效率比较,差异无统计学意义（P〉0．05）;氟康唑组、伊曲康唑组分别与氟康唑联合药醋组,其指甲真菌病的总有效率比较,差异无统计学意义（P〉0．05）,而趾甲（合并指甲）真菌病的总有效率比较,差异有统计学意义（P〈0．05）。结论氟康唑、伊曲康唑、氟康唑联合自制药醋治疗指甲真菌病的临床疗效相似,但氟康唑联合自制药醋治疗趾甲（合并指甲）真菌病的临床疗效优于氟康唑、伊曲康唑。     

Cost effectiveness of oral terbinafine (Lamisil) compared with oral fluconazole (Diflucan) in the treatment of patients with toenail onychomycosis

OBJECTIVE: To determine the cost effectiveness of terbinafine (Lamisil) tablets compared with fluconazole (Diflucan) capsules in the treatment of patients with toenail onychomycosis. METHODS: Data from a randomised, double-blind, double-dummy, multicentre study were used as the basis for this study. Terbinafine 250 mg/day for 12 weeks (n = 48) was compared with fluconazole 150mg once weekly for 12 weeks (n = 45) or 24 weeks (n = 44) in patients with culture-confirmed toenail onychomycosis caused by dermatophyte infection. At the end of the study (week 60), complete clinical cure of the target toenail was achieved in 67% of patients in the terbinafine group, compared with 21 and 32%, respectively, in the 12- and 24-week fluconazole groups. We subsequently used these data to calculate the cost effectiveness of the three treatment regimens, defining cost effectiveness as the cost per complete clinical cure of the target toenail at week 60. RESULTS: The cost effectiveness of terbinafine for each complete clinical cure was superior to that of either of the fluconazole regimens. Costs per cure were Finnish markka (Fmk) 2824 ($US618) for terbinafine, compared with Fmk3748 ($US820) and Fmk4922 ($US1077), respectively, for the two fluconazole regimens. CONCLUSIONS: The clinical study showed that terbinafine was significantly more effective than fluconazole in the treatment of onychomycosis, achieving statistically higher rates of mycological and clinical cure. We have now shown that terbinafine is also more cost effective. These findings have important implications for both medical and social policy.     

伊曲康唑间隙冲击疗法治疗甲真菌病120例

目的观察国产伊曲康唑（易启康）冲击疗法治疗甲真菌病的临床疗效,寻求有效而经济的治疗手段。方法120例甲真菌病患者每天口服易启康2次,每次200mg,连用7d,停药21d为1个疗程。指甲真菌病患者用药2个疗程,趾甲真菌病及指趾甲真菌病伴皮肤感染真菌病患者用药3个疗程,分别观察临床疗效和不良反应情况。结果52例指甲真菌病患者临床痊愈率为90．38％,68例趾甲真菌病及指趾甲真菌病伴皮肤感染真菌病患者临床痊愈率为83．82％,伴皮肤真菌感染者真菌清除率分别为96％和95％,不良反应发生率为4．17％。结论易启康短期冲击疗法治疗甲真菌病疗程短、疗效高、副作用小、安全性高而费用低,值得临床推广使用。     

Pharmacoeconomic analysis of oral antifungal therapies used to treat dermatophyte onychomycosis of the toenails. A US analysis

Until a few years ago, griseofulvin and ketoconazole were the only 2 oral agents available for the treatment of dermatophyte onychomycosis of the toenails. With the availability of the newer antifungal agents, such as itraconazole, terbinafine and fluconazole, the armamentarium of drugs available to treat onychomycosis has expanded. The objective of this study was to determine the relative cost effectiveness of the most commonly used oral antifungal agents in the US for the treatment of dermatophyte onychomycosis of the toenails from the perspective of a third-party payer. The time horizon was 3 years. A 5-step approach was used in this pharmacoeconomic analysis. First, the purpose of the study, the comparator drugs and their dosage regimens were defined. In step II, the medical practice and resource-consumption patterns associated with the treatment of onychomycosis were identified. In step III, a meta-analysis was performed on all studies meeting prespecified criteria, and the mycological cure rates of the comparator drugs were determined. In step IV, the treatment algorithm for the management of onychomycosis was constructed for each drug. The cost-of-regimen analysis for each comparator incorporated the drug acquisition cost, medical-management cost and cost of managing adverse drug reactions. The expected cost per patient, number of symptom-free days (SFDs), cost per SFD and the relative cost effectiveness for the comparator drugs were calculated. In step V, a sensitivity analysis was performed. The drug comparators for this study were griseofulvin, itraconazole (continuous and pulse), terbinafine and fluconazole. The mycological cure rates [mean +/- standard error (SE)] from the meta-analysis were griseofulvin 24.5 +/- 6.7%, itraconazole (continuous) 66.4 +/- 6.1%, itraconazole (pulse) 76 +/- 9.3%, terbinafine 74 +/- 7% and fluconazole 59%. The cost per mycological cure was griseofulvin $US8089, itraconazole (continuous) $US1877, itraconazole (pulse) $US991, terbinafine $US1125 and fluconazole $US1506. The corresponding cost per SFD was griseofulvin $US7.05, itraconazole (continuous) $US2.18, itraconazole (pulse) $US1.26, terbinafine $US1.28 and fluconazole $US2.12. The resulting ratios of cost per SFD relative to itraconazole (pulse) [1.00] were terbinafine 1.02, itraconazole (continuous) 1:73, fluconazole 1.69 and griseofulvin 5.62. In conclusion, in this analysis, itraconazole (pulse) and terbinafine were the most cost-effective therapies for dermatophyte onychomycosis of the toenails, both being substantially more cost effective than griseofulvin.     

Cost effectiveness of continuous terbinafine compared with intermittent itraconazole in the treatment of dermatophyte toenail onychomycosis: an analysis of based on results from the L.I.ON. study. Lamisil versus Itraconazole in Onychomycosis

OBJECTIVE: To compare the costs and effectiveness of 2 oral antifungal treatment regimens in patients with dermatophyte toenail onychomycosis. DESIGN AND METHODS: A cost-effectiveness analysis using a model based on data from the Lamisil versus Itraconazole in Onychomycosis (L.I.ON.) study, a randomised controlled trial comparing continuous terbinafine with intermittent itraconazole. The trial included 4 treatment arms: terbinafine 250 mg/day for 12 or 16 weeks (T12, T16) and itraconazole 400 mg/day for 1 week in every 4 weeks for 12 or 16 weeks (I3, I4). Cost calculations for 6 countries (Finland, Germany, Iceland, Italy, The Netherlands, UK) included costs for medication, physician visits, laboratory tests, management of adverse events and management of relapse. Effectiveness was based on complete cure rates (mycological cure plus 100% toenail clearing). Costs per complete cure were determined and both average and incremental cost-effectiveness ratios were calculated. PERSPECTIVE: Healthcare system. MAIN OUTCOME MEASURES AND RESULTS: In the L.I.ON. study, terbinafine was seen to be more effective than itraconazole (cure rates, 45.8 vs 23.4%). In most comparisons (5 of the 6 countries), the costs of T12 were statistically significantly lower than those of I3 [range: -37 to -173 euros (EUR); 1998 values; 1.172 US dollars = EUR1], indicating that T12 was the dominant strategy (i.e. less expensive and more effective). One exception (Finland) showed an incremental cost-effectiveness ratio of EUR524 per additional cure. In the other 5 countries, T16 and 14 were essentially equal in cost, but the greater effectiveness of T16 (cure rates, 55.1 vs 25.9%) resulted in a situation of extended dominance. CONCLUSION: From a healthcare system perspective, continuous terbinafine is less costly and more effective than intermittent itraconazole in the treatment of dermatophyte toenail onychomycosis.     

Clinical and economic factors in the treatment of onychomycosis

Onychomycosis is a fungal infection of fingernails and toenails, most cases of which are caused by dermatophytes. The disease accounts for 15% of all nail disease, and affects approximately 2 to 3% of people of all ages and both sexes. Topical treatment with tioconazole, amorolfine or ciclopirox has limited effectiveness. Oral griseofulvin 500 to 1000mg daily has been the mainstay of treatment, but prolonged therapy is required and success rates are low. Therapy with itraconazole 200mg daily for 3 to 6 months is more effective (70 to 85% success), although so-called 'pulse' therapy has shown similar success with potentially fewer adverse effects. Terbinafine 250mg daily produces clinical and mycological cure in approximately 80% of patients treated for 6 and 12 weeks for fingernail and toenail infections, respectively. The overall costs of treating onychomycosis are substantial, and it has been estimated that direct costs for Medicare patients with the disease were $US43 million in 1 year. In addition, the disease has a negative impact on quality of life, in the domains of mental functioning, health concern, social functioning, and physical appearance. Few pharmacoeconomic analyses have been published, but all have indicated an advantage of oral terbinafine over griseofulvin and other oral agents. To date, no economic studies have been performed on topical agents, pulse therapy or combination treatments.     

The use of terbinafine in the treatment of onychomycosis in adults and special populations: a review of the evidence

Terbinafine is an allylamine with fungicidal activity, first approved for the treatment of onychomycosis in the United Kingdom in the early 1990s, and in the US in 1996. Terbinafine is the most frequently prescribed oral antifungal agent in the US and Canada for onychomycosis. Its efficacy and safety in dermatophyte toenail onychomycosis in adults has been established in many studies. In fact, 18 randomized controlled trials have shown terbinafine to be highly effective, with a meta-average for mycological cure of 76% +/- 3% (mean +/- standard error). In large surveillance studies, terbinafine exhibited excellent safety profiles consistent with results obtained in pivotal studies. Additionally, terbinafine has been reported to be superior to both itraconazole and fluconazole in comparative studies in the treatment of dermatophyte toenail onychomycosis. Recent studies have reported terbinafine to be more cost effective than griseofulvin, fluconazole, or itraconazole. Terbinafine has also been used to treat onychomycosis effectively and safely in special patient populations, such as children, the elderly, immunocompromised patients, diabetics, and those with Down syndrome. Terbinafine should therefore be considered for the management of onychomycosis in adults based on its effectiveness, broad spectrum, fungicidal nature, established safety profile, and very low occurrence of drug interactions. Furthermore, the data support the use of terbinafine to treat dermatophyte onychomycosis in children and the elderly.     

序贯疗法治疗甲真菌病的临床研究

目的:探讨不同治疗方案对甲真菌病的作用及不良反应。方法:对125例甲真菌病患者分别采用伊曲康唑和特比萘芬序贯疗法、伊曲康唑冲击治疗和特比萘芬连续治疗,对其临床效果及不良反应进行评价。结果:三组具有相似的临床疗效,但序贯疗法更安全、经济。结论:序贯疗法是治疗甲真菌病的最佳治疗方案。     

5种不同用药方案治疗念珠菌性阴道炎的经济学评价

目的：探讨不同给药方案治疗念珠菌性阴道炎的经济学效果。方法：将189例念珠菌性阴道炎患者以随机抽样法分为5组,分别给予氟康唑片（A组）、伊曲康唑胶囊（B组）、克霉唑阴道片（C组）、氟康唑片＋克霉唑阴道片（D组）、伊曲康唑胶囊＋克霉唑阴道片（E组）,运用药物经济学方法进行成本-效果分析。结果：5组成本分别为15.57、51.18、13.60、29.17、64.78元;有效率分别为80%、89.5%、80.6%、97.5%、97.5%;成本-效果比分别为19.46、57.18、16.87、29.18、66.44;A、B、D、E组方案相对于C组方案的增量成本-效果比分别为-3.28、4.22、0.92、3.03。结论：治疗念珠菌性阴道炎的5种方案中,氟康唑片＋克霉唑阴道片方案较佳。     

Ciclopirox topical solution, 8% combined with oral terbinafine to treat onychomycosis: a randomized, evaluator-blinded study

This randomized, evaluator-blind, 3-arm parallel, comparator controlled, multicenter pilot study evaluated the safety and efficacy of ciclopirox nail lacquer topical solution, 8% in combination with oral terbinafine for the treatment of moderate to severe toenail onychomycosis (> or =60% disease involvement of target nail and/or lunula/matrix involvement) (N = 73). Patients were randomized to 1 of 3 treatment arms: ciclopirox nail lacquer once daily for 48 weeks plus 4 weeks of terbinafine 250 mg/day, followed by 4 weeks of rest (no terbinafine), then another 4 weeks of terbinafine 250 mg/day (PLs); ciclopirox nail lacquer once daily for 48 weeks plus terbinafine 250 mg/day for 12 weeks (PL12); or terbinafine 250 mg/day for 12 weeks (L12). At week 48, mycological cure (negative microscopy and culture) occurred in 66.7% (14/21) (PL8), 70.4% (19/27) (PL12), and 56.0% (14/25) (L12) of patients confirmed dermatophyte positive, respectively (P: not significant). At this time point, effective cure (simultaneous mycological cure and > or =90% reduction in the disease area) was observed in 40.0% (8/20), 33.3% (8/24), and 34.8% (8/23) of patients, respectively (P: not significant). The PLs regimen was well-tolerated and had high compliance. The data suggest that combination therapy (PL8) may be an alternative regimen to continuous terbinafine (L12) in the treatment of moderate to severe dermatophyte toenail onychomycosis.