We read with interest the article by Alam and Stiller,1 in particular the conclusions that they reach as to the cost advantages of the treatment modalities considered for external genital warts (EGWs). We have concerns about the article and the conclusions that were reached. The methodology adopted by the authors is inappropriate with regard to the assessment of cost-effectiveness in treating a disease such as EGWs, in which recurrence is a critical issue. Regarding the article by Langley et al,2 we were concerned that the impact of high recurrence rates in EGW treatment was only poorly understood and that physicians were accepting claims for cost-effectiveness based on models of treatment that do not represent the decisions faced in a real world environment. Unfortunately, Alam and Stiller explicitly exclude any consideration of recurrence and the long-run efficacy of treatment, therapy switching, and/or the use of combination therapy.3 As a result, their analysis is flawed, and we doubt that their results can be considered a guide to the cost advantages of competing modalities.
Raymond T. Kuwahara, Robert B. Skinner, Stephen K. Tyring. Direct Medical Cost for Surgical and Medical Treatment of Condylomata Acuminata. Arch Dermatol. 2002;138(4):533–534. doi:10.1001/archderm.138.4.533