How cost-effective is oral isotretinoin?

Purpose: To consider whether oral isotretinoin (Roaccutane(R)/Accutane(R)) represents good value compared with typical alternative treatments for moderate or severe acne. Procedures: Published reports were reviewed on the comparative effectiveness of oral isotretinoin and its alternatives and on their relative costs. Results: Observational studies of clinical and patient-assessed outcomes suggest that oral isotretinoin is much more effective than available alternatives. The costs of treatment with isotretinoin are greater in the first year, but substantial cost savings accrue in subsequent years. Conclusions: Isotretinoin is more cost-effective than long-term antibiotic therapy mainly because of its greater efficacy but also because of long-term cost savings. Message: The costs and benefits of alternative treatments for acne should be assessed over a period of at least years, preferably longer. The higher initial cost of oral isotretinoin should not be a barrier to its use where the drug is clinically indicated.