A clinical trial commissioned by the NIHR Health Technology Assessment (HTA) programme will investigate which of two common treatments for verrucae, cryotherapy and salicylic acid (SA), is the most effective and cost-effective [www.hta.ac.uk/project.asp?PjtId=1532]. Almost two million people see their GP about verrucae and warts every year, costing the NHS at least £40 million. The clinical trial follows reviews of existing research evidence which suggest that self treatment at home with SA bought over the counter may be just as effective as visiting a GP for treatment.
In the study, led by researchers at the University of York, half of patients (aged 12-25) will self-treat with SA, while the other half will undergo cryotherapy delivered by a health professional. They will be followed up for 12 weeks to compare cure rates. Participants will also be asked about any side effects they experience and their satisfaction with their treatment. A record will be kept of the number of times they see the health care professional, allowing estimates of the likely cost to patients and the NHS to be made.
An HTA-funded review of the existing research evidence published this summer [www.hta.ac.uk/project.asp?PjtId=1348], found little evidence to suggest that cryotherapy is any more effective than SA. Of the treatments commonly prescribed by GPs for warts, SA was the most cost effective, although it was found that cryotherapy delivered through nurse-led clinics could be a cost effective alternative. The team from the Centre of Evidence Based Dermatology, University of Nottingham also found, however, that both GP prescribed SA and nurse-led cryotherapy clinics are expensive compared to self-treatment. Overall, over the counter (OTC) therapies were the most cost-effective treatment options, with SA the most commonly used of these.
The researchers said that, given the minor nature of most warts, coupled with the fact that the majority spontaneously resolve in time, these findings suggest that a shift towards self-treatment could be warranted. The findings were used to inform the design of the new clinical trial to help ensure that this question can be answered.
"Because verrucae are seen as a minor condition, few trials have been funded into the best treatments for them," says lead researcher Elizabeth Cockayne. "If this research shows that self treatment with SA is as cost-effective as or more cost-effective than conventional treatments, a shift in service delivery away from primary care towards more OTC treatment is likely, although more research will be required to investigate the efficacy of other OTC preparations, particularly cryotherapy."
Notes for editors:
1. Incidence figures estimated from the 4th National Morbidity Survey (1991-92) suggest that almost 2 million people see their GP per year about warts, at a cost of at least £40 million per annum.
2. What is the effectiveness and cost-effectiveness of salicylic acid and cryotherapy for cutaneous (non-genital) warts - an economic decision model was published in the Health Technology Assessment journal series Vol. 10.25 [www.hta.ac.uk/project.asp?PjtId=1348 ].
3. The HTA programme produces high quality research information about the effectiveness, costs, and broader impact of health technologies for those who use, manage and provide care in the NHS. This is a programme of the National Institute for Health Research (www.nihr.ac.uk) and is the largest and longest running of the national programmes with 360 projects published since its inception in 1993. About 50 are published each year, all available for download free of charge from the website. It is coordinated by the National Coordinating Centre for Health Technology Assessment (NCCHTA), based at the University of Southampton. Visit www.hta.ac.uk for more information.
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