Head lice treatment costs and the impact on managed care.

The number of head lice infestations occurring annually in the United States is estimated at 6 million to 12 million. Although a formal economic analysis of head lice treatments has not been conducted, the direct cost of treatment can be roughly estimated by considering the costs of pediculicides and taking into consideration that patients may self-treat up to 5 times before seeking medical care. Added to the direct costs of treatment are indirect costs because of lost school days and lost productivity and wages of parents who must stay home to care for children who are sent home from schools that employ no-nit policies. The cost of head lice infestation is tied to diagnostic and treatment practices. Research suggests that head lice infestations are frequently misdiagnosed. In addition, over-the-counter treatments are often used incorrectly. The combination of misdiagnosis and improper treatment has contributed to decreased efficacy of pediculicides. This, in turn, further contributes to ineffective treatment and the necessity for retreatment and related increases in costs. Lindane, a prescription pediculicide, is associated with serious safety concerns and is now recommended for use in selected populations only when conventional treatment fails. Malathion 0.5% is the only prescription pediculicide that is considered to be safe and effective with no decrease in efficacy over time. Managed care organizations, in collaboration with school nurses and other healthcare providers, are working to promote more accurate diagnosis and proper use of pediculicides. The objectives of these efforts are to make the treatment of head lice more effective and ultimately to lower the cost of treatment by introducing better options early on.