The combination drugs cost more, too. Fleischer estimated that the combination drugs cost the nation's health care system $10.3 million to $24.9 million during the five years studied, depending on the drug prescribed. And this conservative estimate does not include the cost of additional office visits and prescriptions that would have been required in cases where the combination agent did not clear up the infection.
Roughly two-thirds of the visits to non-dermatologists were to family or general practitioners. They prescribed combination agents in 29 percent of the visits. Visits to internists accounted for about a sixth of the visits to non-dermatologists. They prescribed combination agents 51 percent of the time.
Fleischer conjectured that the doctors prescribing combination agents may do so because these drugs would seem to fit the symptoms.
"With some fungal infections there is a great amount of inflamation and irritation of the skin, and the patient has itching and burning," Fleischer said. These doctors may prescribe combination agents so that the cortisone can relieve the inflamation, not realizing that it negates the anti-fungal drug.
"The reason there's inflamation," Fleischer said, "is there's an infection, and the best way to treat the infection is to treat the infection, rather than the inflamation that results from the infection."
The study has important implications for HMOs, which, to reduce costs, typically require that patients first be seen by a primary care doctor, Fleischer said.
"What we are interested in are cost-effective outcomes for patients--that is, getting a patient to disease resolution quickly and efficiently.
"It might be assumed that treatment of skin disease is very
straightforward, and that there are only two creams and you use Cream A or Cream
B. But in
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Contact: Robert Conn or Jim Steele
RConn@WFUBMC.edu
336-716-4587
Wake Forest University Baptist Medical Center
1-Jul-1998