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

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.