Philadelphia—Greater use of prescription topical treatments could better manage healthcare costs for cutaneous warts, which are responsible for several million office visits per year, according to a new study.

Researchers and colleagues from the Perelman School of Medicine at the University of Pennsylvania embarked on a study after determining that, "while multiple treatments are available, including topical treatments, intralesional immunotherapy, and cryotherapy, little is known about healthcare utilization and costs associated with different treatments." The study was published as a research letter in the Journal of the American Medical Association Dermatology.

In a retrospective, cohort study conducted using the deidentified Optum Clinformatics Database from January 1, 2017, through December 31, 2019, the authors sought to quantify annual healthcare utilization and costs associated with common cutaneous and anogenital wart treatments. Those included cryotherapy, intralesional immunotherapy, and prescription topical treatments.

Prescription topical treatments were podofilox, podophyllin, imiquimod, and sinecatechins. The study team also looked at prescriptions that may be used for warts but also have alternate indications (adapalene, bexarotene, tazarotene, and tretinoin).

On average, 263,070 individuals with cutaneous warts and 28,516 individuals with anogenital warts were identified each year from 2017 through 2019. Cutaneous wart patients had a mean age of 44 years, 52% were female, and 81% were white. For patients with anogenital warts, the mean age was 43 years, 40.7% were female, and 70% were white.

In terms of therapies, researchers reported that for cutaneous warts, on average, 64.2% of individuals were treated with lesional destruction, 1.8% with intralesional injection, and 2.2% with prescription topical medications. For anogenital warts, on average, 35.3% of individuals were treated with lesional destruction, 0.6% with intralesional injection, and 16.5% with prescription topical medications.

The study team estimated annual costs in 2019 of $846 million for cutaneous warts (lower bound, $431 million; upper bound, $850 million) and $127 million for anogenital warts (lower bound, $90 million; upper bound, $127 million).

"In this claims-based study, we estimate a 2019 U.S. annual cost of more than $800 million for wart treatment within the commercially insured population, with most cost-driven by lesional destruction and management costs, rather than intralesional injections or prescription topical medications," researchers explained. "Per-patient costs were $288.28 for cutaneous warts and $431.47 for anogenital warts."

The authors added that while procedural treatments such as cryotherapy remain the most common treatment approaches, they are associated with high costs. They also noted, "Given the limited effectiveness and adverse effects of these treatments, more effective topical treatments may be valuable for streamlining care and reducing population-level costs."

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