Carbon Dioxide Laser for Anogenital Warts

Summary

A systematic review 1 evaluated the clinical effectiveness and cost-effectiveness of interventions for the treatment of anogenital warts. 60 randomised controlled trials (RCTs) evaluating 19 interventions were included. Analysis by mixed-treatment comparison (MTC) indicated that ablative techniques were typically more effective than topical interventions at completely clearing warts at the end of treatment. Podophyllotoxin 0.5% solution was found to be the most effective topical treatment evaluated. Networks for other outcomes included fewer treatments, which restrict conclusions on the comparative effectiveness of interventions. Podophyllotoxin 0.5% solution first line followed by carbon dioxide (CO2) laser therapy second line if warts did not clear was most likely to be considered a cost-effective use of resources at a willingness to pay of £20,000-30,000 per additional quality-adjusted life-year gained. Forest plots presenting ORs and accompanying 95% CrIs for complete clearance of warts at the end of treatment for the comparison between the interventions and podophyllin 20-25%: podopfhyllin vs placebo 0.053 (0.007 to 0.163); vs podophyllotoxin 0.3% cream 1.84 (0.07 to 8.35); vs cryotherapy 2.11 (0.39 to 6.90); vs cryotherapy plus podophyllotoxin 0.15% cream 6.63 (0.28 to 29.42); vs podophyllotoxin 0.5% solution 11.65 (2.65 to 38.50); vs surgical excision 13.08 (0.48 to 70.51); vs CO2 laser 104.6 (3.35 to 502.2).