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Cost-effectiveness of cryotherapy versus salicylic acid for the treatment of plantar warts: economic evaluation alongside a randomised controlled trial (EVerT trial)

Eugena Stamuli1, Sarah Cockayne1*, Catherine Hewitt1, Kate Hicks1, Shalmini Jayakody1, Arthur Ricky Kang'ombe1, Gwen Turner1, Kim Thomas2, Mike Curran3, Farina Hashmi4, Caroline McIntosh5, Nichola McLarnon6, David J Torgerson1, Ian Watt17 and the EVerT team

Author Affiliations

1 Department of Health Sciences, York Trials Unit, University of York, ARRC Building, York YO10 5DD, UK

2 Centre of Evidence Based Dermatology, University of Nottingham, Nottingham, UK

3 School of Health, University of Northampton, Northampton, UK

4 4 University of Brighton, School of Health Professions, Brighton, UK

5 The National University of Ireland, Galway, Discipline of Podiatry, Galway, Ireland

6 Glasgow Caledonian University, School of Health and Social Care, Glasgow, UK

7 Hull York Medical School, York, UK

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Journal of Foot and Ankle Research 2012, 5:4  doi:10.1186/1757-1146-5-4

Published: 27 February 2012

Abstract

Background

Plantar warts (verrucae) are extremely common. Although many will spontaneously disappear without treatment, treatment may be sought for a variety of reasons such as discomfort. There are a number of different treatments for cutaneous warts, with salicylic acid and cryotherapy using liquid nitrogen being two of the most common forms of treatment. To date, no full economic evaluation of either salicylic acid or cryotherapy has been conducted based on the use of primary data in a pragmatic setting. This paper describes the cost-effectiveness analysis which was conducted alongside a pragmatic multicentre, randomised trial evaluating the clinical effectiveness of cryotherapy versus 50% salicylic acid of the treatment of plantar warts.

Methods

A cost-effectiveness analysis was undertaken alongside a pragmatic multicentre, randomised controlled trial assessing the clinical effectiveness of 50% salicylic acid and cryotherapy using liquid nitrogen at 12 weeks after randomisation of patients. Cost-effectiveness outcomes were expressed as the additional cost required to completely cure the plantar warts of one additional patient. A NHS perspective was taken for the analysis.

Results

Cryotherapy costs on average £101.17 (bias corrected and accelerated (BCA) 95% CI: 85.09-117.26) more per participant over the 12 week time-frame, while there is no additional benefit, in terms of proportion of patients healed compared with salicylic acid.

Conclusions

Cryotherapy is more costly and no more effective than salicylic acid.

Current Controlled Trials ISRCTN18994246 [controlled-trials.com] and National Research Register N0484189151.

Keywords:
Plantar warts; Verrucae; Cost-effectiveness analysis; Salicylic acid; Cryotherapy using liquid nitrogen