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July 5, 1995

The Cost of Topical Drugs for Dermatophyte Infections-Reply

Author Affiliations

University Hospitals of Cleveland Cleveland, Ohio

JAMA. 1995;274(1):27. doi:10.1001/jama.1995.03530010041032

In Reply.  —We thank Drs Perlmutter and Whitmore for their comments. Both letters highlight a remarkable advantage of the type of cost analysis that we proposed: our method compared the cost of treatment with a reference drug with the cost of treatment with alternative drugs of any price.For example, even when clotrimazole is available at the relatively low costs cited by Dr Whitmore (compared with nationwide average wholesale costs), it still remains over three times the cost of miconazole as reported in the 1993 Red Book.1 Assuming a follow-up visit charge of $21.98, the efficacy rate of miconazole would have to be less than 62% before it is always less expensive to begin therapy with clotrimazole (Figure 1 of our article). As we pointed out, published efficacy rates for miconazole—and clotrimazole—vary from 70% to 100%.Perlmutter points out that treatment regimens involving alternatives to drugs are often much

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