Evaluation of Cost-Effectiveness and Patient Satisfaction of Topical, Topical Plus Systemic, and Topical Plus Laser Treatment in Patients with Acne Vulgaris High Level

Indra Ginting; Hassan Basri  Mukhali; Robert Parulian  Sinaga; Tiwanto  Dakhi; Andrey Bayu  Aji; Novi  Supit; Singgar Ni  Rudang; Syahniar  Lubis; Mohd Ihsanuddin Bin  Abas

doi:10.37899/journallamedihealtico.v6i6.2675

Indra Ginting Department of Pharmaceutical Chemistry, Faculty of Pharmacy and Health, Institut Kesehatan Helvetia, Medan, Sumatera Utara, Indonesia
Hassan Basri Mukhali Faculty of Medicine, Universiti Sultan Zainal Abidin, Medical Campus, Jalan Sultan Mahmud 20400 Kuala Terengganu, Malaysia
Robert Parulian Sinaga Faculty of Economics and Business, University of North Sumatra, Medan, Indonesia
Tiwanto Dakhi Faculty of Economics and Business, University of North Sumatra, Medan, Indonesia
Andrey Bayu Aji Erha Clinic Ultimate, Jakarta, Indonesia
Novi Supit Erha Clinic Ultimate, Jakarta, Indonesia
Singgar Ni Rudang Department of Pharmacology and Pharmacy, Clinical/Community Pharmacy, Faculty of Pharmacy, Universitas Sumatra Utara, Medan
Syahniar Lubis Department of Pharmaceutical Chemistry, Faculty of Pharmacy and Health, Institut Kesehatan Helvetia, Medan, Sumatera Utara, Indonesia
Mohd Ihsanuddin Bin Abas Faculty of Medicine, Universiti Sultan Zainal Abidin, Medical Campus, Jalan Sultan Mahmud 20400 Kuala Terengganu, Malaysia

DOI: https://doi.org/10.37899/journallamedihealtico.v6i6.2675

Keywords: Acne Vulgaris, Acne Lesion, Cost-Effectiveness, Patient Satisfaction, VAS, Acne Treatment

Abstract

Acne vulgaris is a prevalent dermatological condition that negatively affects quality of life and psychological well-being. Although topical, systemic, and laser therapies are commonly used, comparative evidence on their effectiveness, patient satisfaction, and cost-effectiveness in Southeast Asia remains limited. This prospective cohort study was conducted at Erha Clinic from April 2024 to March 2025. Ninety patients with acne vulgaris were evenly allocated into three treatment groups: topical monotherapy, topical plus systemic therapy, and topical plus laser therapy. Clinical effectiveness was assessed using lesion counts and the Investigator Global Acne (IGA) scale, patient satisfaction using the Visual Analogue Scale (VAS), and cost-effectiveness through total cost and cost per lesion reduction. Measurements were taken at baseline and at weeks 2, 4, 8, and 12. Data were analyzed using IBM SPSS version 22. All treatment modalities significantly reduced acne lesions and improved IGA scores and patient satisfaction. Topical plus laser therapy achieved the fastest and greatest lesion reduction and highest satisfaction but incurred the highest cost. Topical monotherapy demonstrated comparable long-term clinical outcomes with the lowest cost per lesion reduced, indicating superior cost-effectiveness. All treatments were clinically effective; however, topical monotherapy was the most cost-effective option, while topical plus laser offered faster results at higher cost. Treatment selection should balance clinical benefits and economic considerations, particularly in resource-limited Southeast Asian settings.

References

Alkeraye, S., Alosaimi, K., Alrabiah, H. F., Alkahtani, R., Alshehri, N. A., & Alharbi, B. A. (2024). Acne scars impact on the quality of life and the willingness to pay for treatments among adults in Riyadh, Saudi Arabia: A cross-sectional study. Journal of Cutaneous and Aesthetic Surgery, 17(3), 205–213. https://doi.org/10.25259/jcas_154_23

Azimi, N. A., & Welch, H. G. (1998). The effectiveness of cost‐effectiveness analysis in containing costs. Journal of general internal medicine, 13(10), 664-669. https://doi.org/10.1046/j.1525-1497.1998.00201.x

Bertram, M. Y., Lauer, J. A., Stenberg, K., & Edejer, T. T. T. (2021). Methods for the Economic Evaluation of Health Care Interventions for Priority Setting in the Health System: An Update From WHO CHOICE. International Journal of Health Policy and Management, 10(11), 673–677. https://doi.org/10.34172/ijhpm.2020.244

Bienenfeld, A., Nagler, A. R., & Orlow, S. J. (2017). Oral antibacterial therapy for acne vulgaris: an evidence-based review. American journal of clinical dermatology, 18(4), 469-490. https://doi.org/10.1007/s40257-017-0267-z

Brent, R. J. (2023). Cost-benefit analysis versus cost-effectiveness analysis from a societal perspective in healthcare. International Journal of Environmental Research and Public Health, 20(5), 4637. https://doi.org/10.3390/ijerph20054637

Chen, Y., Sun, S., Yang, H., Xie, M., Fei, X., Zhang, Y., ... & Ding, X. (2025). Global prevalence of mental health comorbidity in patients with acne: an analysis of trends from 1961 to 2023. Clinical and Experimental Dermatology, 50(6), 1083-1093. https://doi.org/10.1093/ced/llae531

Chuah, S. Y., & Goh, C. L. (2015). The Impact of Post-Acne Scars on the Quality of Life Among Young Adults in Singapore. Journal of Cutaneous and Aesthetic Surgery, 8(3), 153–158. https://doi.org/10.4103/0974-2077.167272

Dhaher, S. A., & Yosif, A. M. (2022). Efficacy and safety of 1064 nm long-pulsed neodymium-doped yttrium garnet (Nd:YAG) laser for treating acne vulgaris: a prospective clinical trial. Iranian Journal of Dermatology, 25(4), 356–362. https://doi.org/10.22034/ijd.2021.286989.1371

Dreno, B., Amici, J. M., Demessant-Flavigny, A. L., Wright, C., Taieb, C., Desai, S. R., & Alexis, A. (2021). The impact of acne, atopic dermatitis, skin toxicities and scars on quality of life and the importance of a holistic treatment approach. Clinical, cosmetic and investigational dermatology, 623-632. https://doi.org/10.2147/CCID.S315846

Ginting, I., bin Mukhali, H. B., Abas, M. I. B., Aji, A. B., Supit, N., & Rudang, S. N. (2025). Evaluation of Cost-Effectiveness and Patient Satisfaction of Topical, Topical Plus Systemic, and Topical Plus Laser Treatment in Patients with Acne Vulgaris. Journal of Asian Multicultural Research for Medical and Health Science Study, 6(2), 28-47.

Gollnick, H. P., Bettoli, V., Lambert, J., Araviiskaia, E., Binic, I., Dessinioti, C., ... & Dréno, B. (2016). A consensus‐based practical and daily guide for the treatment of acne patients. Journal of the European Academy of Dermatology and Venereology, 30(9), 1480-1490. https://doi.org/10.1111/jdv.13675

Halvorsen, J. A., Stern, R. S., Dalgard, F., Thoresen, M., Bjertness, E., & Lien, L. (2011). Suicidal ideation, mental health problems, and social impairment are increased in adolescents with acne: A population-based study. Journal of Investigative Dermatology, 131(2), 363–370. https://doi.org/10.1038/jid.2010.264

Hammoda, T. M., Ahmed, N. A., & Hamdino, M. (2023). Fractional CO2 laser versus 1064-nm long-pulsed Nd:YAG laser for inflammatory acne vulgaris treatment: a randomized clinical trial. Lasers in Medical Science, 38(1), 187. https://doi.org/10.1007/s10103-023-03855-6

Heng, A. H. S., & Chew, F. T. (2020). Systematic review of the epidemiology of acne vulgaris. Scientific Reports, 10(1). https://doi.org/10.1038/s41598-020-62715-3

Ip, A., Muller, I., Geraghty, A. W. A., McNiven, A., Little, P., & Santer, M. (2020). Young people’s perceptions of acne and acne treatments: secondary analysis of qualitative interview data. British Journal of Dermatology, 183(2), 349–356. https://doi.org/10.1111/bjd.18684

Layton, A. M., Thiboutot, D., & Tan, J. (2021). Reviewing the global burden of acne: how could we improve care to reduce the burden?. British Journal of Dermatology, 184(2), 219-225. https://doi.org/10.1111/bjd.19477

Mallon, E., Newton, J. N., Klassen, A., STEWART‐BROWN, S. L., Ryan, T. J., & Finlay, A. Y. (1999). The quality of life in acne: a comparison with general medical conditions using generic questionnaires. British Journal of Dermatology, 140(4), 672-676. https://doi.org/10.1046/j.1365-2133.1999.02768.x

Mavranezouli, I., Daly, C. H., Welton, N. J., Deshpande, S., Berg, L., Bromham, N., Arnold, S., Phillippo, D. M., Wilcock, J., Xu, J., Ravenscroft, J. C., Wood, D., Rafiq, M., Fou, L., Dworzynski, K., & Healy, E. (2022). A systematic review and network meta-analysis of topical pharmacological, oral pharmacological, physical and combined treatments for acne vulgaris. British Journal of Dermatology, 187(5), 639–649. https://doi.org/10.1111/bjd.21739

Mavranezouli, I., Welton, N. J., Daly, C. H., Wilcock, J., Bromham, N., Berg, L., Xu, J., Wood, D., Ravenscroft, J. C., Dworzynski, K., & Healy, E. (2022). Cost-effectiveness of topical pharmacological, oral pharmacological, physical and combined treatments for acne vulgaris. Clinical and Experimental Dermatology, 47(12), 2176–2187. https://doi.org/10.1111/ced.15356

McNeil, M. P., Luthy, K. E., Platt, C. R., Robinson, M. S., & Macintosh, J. L. B. (2023). First-line acne treatment: efficacy and comparison of cost. The Journal for Nurse Practitioners, 19(6). https://doi.org/10.1016/j.nurpra.2023.104616

Mosca, S., Ottaviani, M., Briganti, S., Di Nardo, A., & Flori, E. (2025). The Sebaceous Gland: A Key Player in the Balance Between Homeostasis and Inflammatory Skin Diseases. Cells, 14(10), 747. https://doi.org/10.3390/cells14100747

Olugbade, I. D., Petty, A. C., & Imahiyerobo-Ip, J. (2025). Treatment of Acne Vulgaris With a 650-ms, 1064-nm Nd:YAG Laser: A Retrospective Study. Journal of Cosmetic Dermatology, 24(2). https://doi.org/10.1111/jocd.16711

Otlewska, A., Baran, W., & Batycka-Baran, A. (2020). Adverse events related to topical drug treatments for acne vulgaris. Expert opinion on drug safety, 19(4), 513-521. https://doi.org/10.1080/14740338.2020.1757646

Penna, P., Meckfessel, M. H., & Preston, N. (2014). Fixed-dose combination gel of adapalene and benzoyl peroxide plus doxycycline 100 mg versus oral isotretinoin for the treatment of severe acne: efficacy and cost analysis. American Health & Drug Benefits, 7(1), 37.

Sandoval, L. F., Hartel, J. K., & Feldman, S. R. (2014). Current and future evidence-based acne treatment: a review. Expert opinion on pharmacotherapy, 15(2), 173-192. https://doi.org/10.1517/14656566.2014.860965

Santer, M., Burden-Teh, E., & Ravenscroft, J. (2024). Managing acne vulgaris: an update. Drug and Therapeutics Bulletin, 62(1), 6-10. https://doi.org/10.1136/dtb.2023.000051

Sapra, S., Lultschik, S. D., Vh Tran, J., & Dong, K. (2022). Concomitant Therapy of Oral Isotretinoin with Multiplex Pulsed Dye Laser and Nd. 15(9), 20–24.

Smith, K. R., & Thiboutot, D. M. (2008). Thematic review series: skin lipids. Sebaceous gland lipids: friend or foe?. Journal of lipid research, 49(2), 271-281. https://doi.org/10.1194/jlr.R700015-JLR200

Tan, N., Vary, J. C., & O’Connor, K. M. (2024). Treatment of Common Dermatologic Conditions. Medical Clinics, 108(5), 795-827.

Tayel, K., Attia, M., Agamia, N., & Fadl, N. (2020). Acne vulgaris: prevalence, severity, and impact on quality of life and self-esteem among Egyptian adolescents. Journal of the Egyptian Public Health Association, 95. https://doi.org/10.1186/s42506-020-00056-9

Tuchayi, S. M., Makrantonaki, E., Ganceviciene, R., Dessinioti, C., Feldman, S. R., & Zouboulis, C. C. (2015). Acne vulgaris. Nature reviews Disease primers, 1(1), 1-20. https://doi.org/10.1038/nrdp.2015.29

Vasam, M., Korutla, S., & Bohara, R. A. (2023). Acne vulgaris: A review of the pathophysiology, treatment, and recent nanotechnology based advances. Biochemistry and Biophysics Reports, 36. https://doi.org/10.1016/j.bbrep.2023.101578

Wasitaatmadja, S. M., Arimuko, A., Norawati, L., Bernadette, I., & Legiawati, L. (2016). PedomanTata Laksana Akne di Indonesia.

Wilcock, J., Kuznetsov, L., Ravenscroft, J., Rafiq, M. I., Healy, E., & Guideline Committee. (2021). New NICE guidance on acne vulgaris: implications for first-line management in primary care. The British Journal of General Practice, 71(713), 568. https://doi.org/10.3399/bjgp21X717977

Worret, W. I., & Fluhr, J. W. (2006). Acne therapy with topical benzoyl peroxide, antibiotics and azelaic acid. JDDG: Journal der Deutschen Dermatologischen Gesellschaft, 4(4), 293-300. https://doi.org/10.1111/j.1610-0387.2006.05931.x

Xiao, Y., Chen, L., Jing, D., Deng, Y., Chen, X., Su, J., & Shen, M. (2019). Willingness-to-pay and benefit–cost analysis of chemical peels for acne treatment in China. Patient Preference and Adherence, 13, 363–370. https://doi.org/10.2147/PPA.S194615

Xu, J., Huang, S., Fu, Z., Zheng, W., Luo, W., Zhuang, N., Liu, L., He, R., & Yang, F. (2025). Effects of light and laser therapies on the microecosystem of sebaceous glands in acne treatment. Photodermatology Photoimmunology and Photomedicine, 41(1). https://doi.org/10.1111/phpp.70005