Cost-effectiveness of a hydroquinone/tretinoin/fluocinolone acetonide cream combination in treating melasma in the United States

Background: Melasma, a disorder of facial hyperpigmentation, presents a treatment obstacle to many physicians. Combination therapy with hydroquinone, tretinoin, and fluocinolone acetonide has proven effective, but it is generally more expensive than other treatments. Objective: To assess the cost-effectiveness of daily triple combination therapy (TCT) compared with daily use of each possible pair of agents (dyads) and twice daily use of hydroquinone (HQ) alone from a payer's perspective. Methods: Efficacy data were obtained from two clinical trials with the primary endpoint being complete clearance at 8 weeks. For all treatments, total cost per successful treatment was calculated. The incremental cost-effectiveness ratio (ICER) was calculated for each dyad and for HQ monotherapy in comparison with TCT. Sensitivity analyses for efficacy and number of office visits were similarly performed. Results and Conclusion: TCT consistently had the lowest cost per primary success in all the analyses performed. Furthermore, ICERs were low, indicating that TCT's superior efficacy is attained at marginal cost increases. Our results indicate that TCT is the most cost-effective treatment when compared with any of its dyads or with hydroquinone alone.