16668 Pulsed dye laser is more cost-effective than topical brimonidine and topical oxymetazoline for the treatment of erythematotelangiectatic rosacea: A systematic review of the literature and meta-analysis

Abstract

We performed a cost-analysis comparing pulsed dye laser (PDL), topical brimonidine, and topical oxymetazoline for treatment of erythematotelangiectatic rosacea (ETR). For the topicals, we calculated the number needed to treat to achieve a two-grade Clinician Erythema Assessment (CEA) improvement. For PDL, physician-reported 50% erythema improvement was used as CEA was not frequently assessed in PDL studies. For the topicals, data was obtained from their phase III trials. For PDL, we performed a meta-analysis of prospective studies evaluating PDL for ETR identified through systematic literature review. Six studies containing 93 patients were analyzed as they reported the outcome of interest. To assess cost, we used the lowest price for the topicals listed on goodrx.com and our institutional PDL cost. In the topical brimonidine and oxymetazoline trials, 55% and 40.1% achieved a two-grade improvement in CEA respectively. In our PDL meta-analysis, 60.2% (56/93) achieved a 50% reduction in physician-reported erythema. PDL patients required an average of 2.96 treatments. Based on the average length of PDL follow-up (14.3 weeks), cost to achieve our outcome of interest was $2159.47 for PDL, $2923.77 for topical brimonidine, and $4567.72 for topical oxymetazoline. This suggests PDL is the most cost-effective modality for treating ETR. Our study likely overestimated PDL cost as PDL likely creates durable improvement beyond the 14.3-week cost-analysis period; whereas, topicals require continued daily application to maintain benefit. Limitations of our study include use of a surrogate outcome to compare efficacy and heterogeneity and poor quality of the PDL studies (eg, no control groups).