Topical Minoxidil: Efficacy and Cost-Effectiveness in Hair Loss Treatment

In 1987, a survey by Robert S. Stern, MD, revealed that over 70% of 552 dermatologists had prescribed topical minoxidil for hair loss, with less than 10% of them accounting for more than half of the prescriptions. Despite concerns about effectiveness and cost, over 100,000 patients were estimated to be receiving the treatment annually in the U.S., with serious complications rarely reported. Studies by DeVillez and Olsen et al. showed limited success in hair regrowth, with only 14% of patients experiencing a significant increase in terminal hairs and an average increase of 365 terminal hairs per square inch, respectively. The cost of treatment was high, at $715 per patient per year, and the cost-effectiveness was questionable, with a potential cost of $14,300 per patient who improved substantially if only 5% responded. Patient self-assessment of treatment success was higher than that of investigators, with 59% reporting at least a moderate response versus 24% by investigators. The document concluded that the likelihood of cosmetically acceptable hair regrowth was probably less than 25%, and possibly closer to 15% or less, likening minoxidil treatment to a costly lottery with uncertain outcomes.