Cost-effectiveness analysis of using dermatologists versus pediatricians to treat mild to moderate acne.

Objective: To assess the cost-effectiveness from the payer perspective of using dermatologists versus pediatricians to treat acne in adolescents ages 10-18.

Methods: A Markov model was constructed to explore outcomes over a 2-year period from the US private payer perspective. Patients ages 10-18 with acne entered the model under the "dermatologist"and "pediatrician" conditions. In each 3-month cycle,each modeled patient received topical retinoids,benzoyl peroxide (BP), antibiotics, or no treatment,and could progress to an acne-free state or remain in an acne state.

Results: The average patient spent42.3% of the time in acne-free states under the dermatologist condition and 28.0% of the time in acne-free states under the pediatrician condition.The cohort of 1000 patients experienced 1900 total quality-adjusted life years (QALYs) at a cost of $2.33 million in the dermatologist condition and 1883 total QALYs at a cost of $1.62 million in the pediatrician condition, yielding an ICER of $40,000/QALY. Most sensitivity analyses confirmed the base case results.

Conclusion: Dermatologist treatment appears cost-effective related to producing additional QALYs at a cost of less than $100,000 per QALY gained. Health plans should consider creating incentives to direct enrollees to dermatologists for acne treatment.