Cost-effectiveness of atenolol compared to propranolol as first-line treatment of infantile haemangioma: A pilot study

Propranolol is the first-line agent for the treatment of infantile haemangioma (IH). Due to its non-selective beta blockade respiratory adverse events are commonplace. Atenolol is a selective beta-1 antagonist and is a second line for patients with a significant respiratory history or those intolerant of propranolol. Previous studies suggest that the two treatments are equally efficacious; however; the narrow side effect profile and once-daily administration of atenolol makes it an attractive alternative. The aim of this study was to compare the cost-effectiveness of atenolol and propranolol in the treatment of IH. Over a two-year period, five patients with nine IH received the first-line treatment with atenolol. Nine individual lesions from six propranolol patients were matched to these lesions, according to patient demographics and IH characteristics. Treatment response was determined by two independent clinician using both the Visual Analogue Score (VAS) and Haemangioma Activity Score (HAS). A cost-analysis of those treated with atenolol was undertaken and compared to the equivalent costing for standard and maximum dose propranolol. Treatment efficacy of atenolol was comparable to propranolol with mean change in VAS and HAS scores of -7.0 (vs -7.2) and 6.1 (vs 5.7), respectively. The cost analysis revealed atenolol was over 20 times less expensive than standard dose propranolol. In conclusion, the findings of this study suggest that atenolol is significantly less expensive and at least as effective as propranolol. These findings highlight the need for a multicentre randomised controlled trial to further investigate the cost-effectiveness of these two agents in the treatment of IH.