The unique pharmacoeconomic burden in managing head lice infestation

Introduction Many factors other than product cost determine the pharmacoeconomic burden of head lice treatment. Tangible costs also include loss of income, cost of physician appointment, transport to the physician office, as well as intangible costs of lost time and productivity in school or work. This is further complicated by the number of applications to completely eliminate the lice and the number of cohabitants that must be treated. This analysis focuses on the cost of product to accomplish a complete course of treatment per product labeling, but importantly, it is adjusted to account for varying hair length: the adjusted cost of a course of treatment (aCCOT). Methods The current average wholesale price (AWP) was obtained from a single source for each product and, based on product labeling, the complete cost of a course of treatment was calculated. These costs were baseline-indexed to the least expensive over-the-counter agent, to allow multiplier comparisons. As length of hair is not a universal parameter used in label dosing guidance, a factor of 1 was given to short hair, 1.5 given to medium length hair, and 2 given to long hair to adjust for the approximated further cost of additional treatment product. Results The comparative aCCOT for head lice treatment based on product labeling of six different agents was baseline-indexed to pyrethrin, with the lowest pyrethrin aCCOT being 1, for short hair. Comparisons to pyrethrin were then derived. For malathion treatment, the aCCOT was 18.8, 28.2, and 37.6 times the pyrethrin baseline aCCOT for short, medium, and long hair respectively. Lindane aCCOT was 9.7, 14.5, and 19.34 times baseline respectively. Ivermectin aCCOT was 25.2, 37.9, and 50.5 times baseline respectively. Spinosad aCCOT was 18.8, 28.2, and 37.6 times baseline respectively. Benzyl alcohol was the most expensive overall with aCCOT at 61.5, 184.5, and 369 times baseline for short, medium, and long hair respectively. Conclusions Important to the overall pharmacoeconomic burden for head lice treatment, product cost is a primary element. The adjusted cost of treatment (aCCOT) varies widely, from 1 - 369-fold by accounting for hair length and number of applications recommended by the product labeling to complete a course of treatment. A clearer idea of product cost under the aCCOT model can support decisions made by the health care provider and patient about product selection within the overall mix of tangible and intangible costs.