Social and economic aspects of acne and the cost-effectiveness of isotretinoin

There has been a shift in the peak age incidence of acne from mid-teens to late teens and early twenties. Acne is therefore making an impact on the working population, although the severity is often mild but persistent. To define cost-effectiveness of isotretinoin in the treatment of acne, data from 100 consecutive patients were examined for 5 years after starting treatment. The median duration of the first course of isotretinoin was 18 weeks (8–43 weeks). Of the patients, 95% had final acne grades of < 1 at the completion of the study. The median dose of isotretinoin was 40 mg (30–80 mg); the median cost of isotretinoin was £306 (£93–1100). By the end of the 5 years 29 patients had relapsed after treatment with a median disease-free interval of 38 months (2–75). Median cost/disease-free year was £192 (£50–3461). Utilities were allocated to acne states by the author and used to derive an estimate of quality-adjusted life-year (QALY). Median cost/QALY was £898. Mildest grades of acne (< 1) produced the highest cost/QALY.