Pharmacoeconomics--an aid to better decision-making.

OBJECTIVES: The first aim of this workshop was to define pharmacoeconomic concepts and terminology. Pharmacoeconomics can be defined as the branch of economics that uses cost-benefit, cost-effectiveness, cost-minimization, cost-of-illness and cost-utility analyses to compare pharmaceutical products and treatment strategies. Economic evaluations provide healthcare decision-makers with valuable information, allowing optimal allocation of limited resources. However, pharmacoeconomics is based on long-term benefits, whereas physicians are typically forced to seek immediate savings. The second aim was to review pharmacoeconomic studies in the field of onychomycosis and finally to discuss future perspectives. RESULTS AND CONCLUSIONS: We discussed current pharmacoeconomic issues on the management of onychomycosis. Consensus was reached on the following issues: * Published pharmacoeconomic studies concerning onychomycosis are flawed. Future studies should be based on internationally validated principles and appropriate models. The fact that costs of different drugs, laboratory examinations and physician visits vary worldwide should be considered. Cost-benefit studies are required. * The National Institute for Clinical Excellence (NICE) recommendations are often considered in countries other than the UK, even when not adapted to the country in question. * Generic drugs might reduce costs, but this depends on their effectiveness (bioavailability). * Sampling requests affect the economic cost (dependent on methodology, which depends on country) and physicians often trust their instincts even when tests are repeatedly negative. * The cost of adverse event management is usually considered to be 10%; this may be too high for onychomycosis, as treatments are relatively safe without severe side-effects. * Probability of recurrence for each drug should be determined. * Need for disease severity standardization, definition of diagnostic criteria and successful treatment (mycological and clinical cure).