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ARTICLE
Page820
RESEARCH
Technology assessment of long-pulsed
Alexandrite laser device for hair removal: A
systematic review
Barmak Yaghoubian1,2, Sakineh Hajebrahimi1, Hamed Pashazadeh3,4, Fariba
Pashazadeh1
1Research center for Evidence-Based Medicine, Health Management and Safety Promotion Research Institute, Tabriz University of
Medical Sciences, Tabriz, Iran / Iranian EBM Centre: A Joanna Briggs Institute Affiliated Group
2North Khorasan University of Medical Sciences, Bojnurd, Iran
3Allameh Tabatabaei University, Tehran, Iran
4Barakat Foundation Subsidiary Board, Tehran, Iran
Corresponding author
Research center for Evidence-Based Medicine,
Health Management and Safety Promotion Research Institute,
Tabriz University of Medical Sciences, Tabriz, Iran
Email: Fariba_Pashazadeh@yahoo.com
Article History
Received: 02 June 2019
Reviewed: 05/June/2019 to 02/August/2019
Accepted: 04 August 2019
Prepared: 10 August 2019
Published: September - October 2019
Citation
Yaghoubian Barmak, Hajebrahimi Sakineh, Pashazadeh Hamed, Pashazadeh Fariba. Technology assessment of long-pulsed
Alexandrite laser device for hair removal: A systematic review. Medical Science, 2019, 23(99), 820-828
Publication License
This work is licensed under a Creative Commons Attribution 4.0 International License.
General Note
Article is recommended to print as color digital version in recycled paper.
REVIEW 23(99), September - October, 2019
Medical Science
ISSN
2321–7359
EISSN
2321–7367
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ABSTRACT
Introduction: Excessive hair removal is one of the issues discussed specifically in cosmetics. To this end, various methods are
available, such as the electrolysis, chemicals, etc., but each of these methods provides advantages and disadvantages. Alexandrite
laser device laser is one of the most popular systems available and suitable for skin type’s I–IV. In this study we aimed to evaluate
this device to determine whether it can be used as an alternative device for other devices. Materials and Methods: A comprehensive
search was conducted in 6 July 2019 via Medline (PubMed), Cochrane Library, Scopus, CRD, NIHR HTA, web of science, Clarivate and
ProQuest databases using PICO-based selected keywords. Afterwards, the retrieved studies were selected by two reviewers. Studies
with no inclusion criteria were excluded. Then, selected studies were assessed by two evaluators using CASP International tool.
Finally, five studies were selected and the obtained data were meta-analyzed by RevMan 5.2 software. In order to compare the costs
and outcomes, the Incremental Cost-effectiveness Ratio (ICER) index and the sensitivity analysis were implemented. Results: This
method is effective and safe. Short-term complications in Diode laser are more than the Alexandrite, Whereas Nd:YAG lasers and
Intense Pulsed Optical Systems(IPLs) generally show less complications than Alexandrite. Patient satisfaction was not different
between any of the methods. There was no difference between the long-pulsed Alexandrite laser, Diode laser, and IPL systems in
light of therapeutic effects, but the only significant difference was seen in reduction rate of the mean amount of hair. The long-
pulsed Alexandrite laser reduced it 16.62% more than the Nd:YAG laser.
Keywords: Alexandrite laser, Incremental Cost-effectiveness Ratio, Diode laser, Intense Pulsed Optical Systems
1. INTRODUCTION
Nowadays removal of excessive hair is one of the most discussed issues in cosmetics and therapeutics. Unwanted and excessive hair
is a common aesthetic problem in many cultures. On the other hand, hirsutism (excessive growth of hair in the androgen-dependent
regions) and hypertrichosis (excessive hair density in each area of the body) may have an adverse effect on mental health by causing
depression and anxiety (Phillips, 2009; Gan and Graber, 2013).
Before the advent of lasers, various treatments for skin Pigmentation disorders including covering the skin with make-up,
whitening with chemicals, peeling (skin peeling), cryotherapy, skin scrubbing, and etc. were used. Removal of hair using traditional
methods can improve the individual's quality of life (Gan and Graber, 2013); But many of these techniques provide temporary
solutions for excessive hair. Although electrolysis may permanently remove hair, it is slow, operator-dependent and it may have
variable outcomes.
The rapid advances in laser technology over the last decades have led medical researchers to take advantage of this technology
in a variety of therapeutic areas and successful treatments have led to an ever-increasing use of this technology. The early utilization
of this technology dates back to the 1990s. Laser therapy has been introduced as a standard treatment for the removal of excessive
hair. This method, leads to a longer period of hairlessness in contrast to other methods.
In the past decade, different lasers with wavelengths with high absorbance by melanin and nanosecond wavelengths were more
effectively and quickly provided for the treatment of these lesions (Wang et al., 2006). In 1996, the 694-nanometer Ruby laser was
the first laser device to be officially studied for hair removal. Long-term treatment, for several minutes on the face and up to several
hours for the back, has limited the use of this laser. Shortly thereafter, the Neodymium or Nd:YAG laser was the first laser treatment
for hair removal approved by the Food and Drug Administration (FDA) in 1997 (Ishikawa et al., 2004). At the same time, the
Alexandrite laser machine was also approved by the FDA in the same year (Administration) and was used by dermatologists and hair
and beauty experts.
Now with the supply of a variety of devices to remove hair, the posed question is that which one of these methods has higher
efficacy and cost-effectiveness. Alexander's laser machine is one of those devices that have recently entered the consumer market
with beauty, skin and hair applications. Therefore, the above-mentioned device should be evaluated for safety, effectiveness and
cost-effectiveness. To this end, this study examines the safety, effectiveness, and cost-effectiveness of Alexander's laser in
comparison to conventional methods for removing hair.
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2. METHOD
The present study is a type of health technology assessment (HTA). The treatment intervention of high-power Alexandrite laser was
compared with conventional methods in terms of safety, effectiveness, ethical considerations and, finally, analyzed by means of cost-
effectiveness. Data of the study has been derived from secondary data and through systematic review and meta-analysis.
First, a systematic review was carried out to find the studies conducted in evaluating the high-power Alexandrite laser device for
the removal of excessive hair. For this purpose, the clinical question (PICO) was designed and related keywords were selected based
on this and the search formula was determined. Then the search was conducted and also updated in 6 July 2019 via Medline
(PubMed), Cochrane Library, Scopus, CRD, NIHR HTA, web of science, Clarivate and ProQuest databases. The keywords "Hair
Removal", "Alexandrite Laser", "Nd:YAG", "Diode" and "IPL" were selected based on the PICO designed to search for documents and
data. These keywords were searched based on Medical Subject headings (MeSH) and free texts. Appropriate search formulas were
synthetized using selected keywords, as well as Boolean operators based on synonyms, using truncation, time limitation, limiting the
type of study to meta-analysis, systematic reviews, health technology assessment, and Randomized Control Trials (RCT) were
determined. In most databases, the final formula for the search for the following formula was determined but, considering the
specific circumstances and characteristics of some databases, this formula was changed. ("Hair Remov* "OR Epilat*) AND
("Alexandrite Laser") AND "(Nd:YAG" OR "Neodymium-doped yttrium aluminium garnet" OR "Diode" OR "IPL" OR "intense pulsed
light").
This search was conducted in Medline (via Ovid), PubMed (clinical queries), Cochrane Library (including CENTRAL, DARE) and
health technology assessment databases such as CRD database and NIHR HTA. In order to find the dissertations in this field, the
proQuest database was searched. The studies inclusion criteria include all randomized clinical trials, systematic reviews, meta-
analyses and economic evaluations that compare long-pulsed Alexandrite laser with other light techniques to eliminate excessive
hair in terms of the means of terminal hair reduction or the sustainability of therapeutic effects of removing hair or side effects after
treatment, and the minimum follow-up period is 6 months.
The exclusion criteria of the studies should not include a long-pulse Alexandrite laser comparative arm solely. For example, long-
pulsed Alexandria laser should be used in combination with other hair removal techniques. The other reason was the use of Q-
Switched Alexandrite in the study. This type of laser is commonly used for Pigmentation disorders. Afterwards, retrieved studies were
selected by two independent professional evidence-based reviewers and were critically appraised. The validity and reliability were
determined using CASP's worksheets, and the selected studies were analyzed using the RevMan v.5.2 software in terms of
probabilistic risk of bias and meta-analysis was conducted in possible cases. Finally, the selected studies were provided to specialists
as well as to economists to be studied in terms of clinical safety, efficacy and cost-effectiveness.
In this research, evaluations were conducted from the perspective of the Ministry of Health and Medical Education as a public
provider and considering the above viewpoints and differences in other alternative methods, all costs and outcomes were identified
and analyzed. In order to analyze the direct and indirect costs associated with each of the alternatives investigating the conducted
studies, international standards and guidelines, and eventually establishing focused discussion groups by getting advice from
dermatologists and experts in the supply chain of laser devices and beauty and hospital experts, the required resources as well as
their complications and consequences were determined.
In addition, ICER incremental cost-efficacy index was used to compare the costs and outcomes of each of the alternatives. The
current indicator will help calculate the additional costs imposed on the system by a unit of increasing effectiveness (reduction of
complications) and provide a suitable criterion for decision making to the policy maker. Also, sensitivity analysis was carried out to
investigate the effects of different values and variables on the impact of each intervention using different scenarios.
3. RESULTS
From 271 articles obtained from searching the references, 107 cases were duplicated titles. 145 articles were removed by reviewing
the title. After selecting the retrieved studies in a stage by stage way, 28 articles reached the abstract review stage from among
which 5 articles included Traditional Review, 3 articles were the guide to use laser and its safety in the treatment of excessive hair
and a non-English and non-Persian article with a low sample size were excluded and 19 articles were selected to full-text studies.
From these articles, 5 RCTs with non-related research questions, a systematic review study of 2007 lacking a proper search strategy
and unclear inclusion and exclusion criteria of studies and therefore were excluded. From the remaining articles, 5 cases lacked
inclusion criteria due to a follow-up for less than 6 months, or combinations of comparable lasers or retrospective study structures
that were excluded from the study. In the next stage, 8 papers remained, all of which were RCT and the CASP checklist and the RCT
evaluation table in REVMAN software were used to evaluate these articles. Among these articles, one was about a particular
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subgroup of patients, and the selection bias was very effective on the outcome. Three other problems were encountered in blinding
and randomization, statistical tests and very inadequate reports. Finally, five RCTs were selected. The complete review of the
accepted papers is presented in Table 1.
Table 1 Evaluating the risk of bias evaluation in the studies used in the report
Study
Type of bias
Davoudi
(2008)
Toosi
(2006)
Ghaly
(2006)
Handrick (2001)
Ayatollahi
(2019)
Random sequence
generation
(selection bias)
Low risk
Unspecified risk
Low risk
Low risk
low risk
Allocation Covering
(Selection Bias)
Low risk
Unspecified risk
Low risk
Low risk
Low risk
Blinding
contributors and
personnel
(implementation
bias)
Low risk
Unspecified risk
Low risk
Unspecified risk
low risk
Blinding in the
assessment of the
results (detection
bias)
Low risk
Low risk
Low risk
Low risk
Low risk
Incompleteness of
the outcome
(attrition bias)
High risk
Low risk
Unspecified
risk
Unspecified risk
low risk
Selected report
(Survey report)
Low risk
Low risk
Low risk
Low risk
low risk
Other biases
Low risk
Low risk
Unspecified
risk
Unspecified risk
Low risk
In terms of safety in 1997, for the first time Finkel et al. reported the effective removal of excessive hair on the face, arms, legs,
and abdomen using the 755 nm long pulsed Alexander laser. In this study which lasted 15 months; Pre-treatment hair counts and
follow-ups per square centimeter was determined to determine the success level. The 755 nm long pulsed laser technology is
effective in removing unwanted hair, whether the hair is light or dark. These results indicated the necessity of treatments for several
times to achieve the desired result. Side effects are minimal and transient. Therefore, this method seems to be safe with proper
treatment and low complications.
In the effectiveness section, several comparisons were performed:
A: The studies were related to the comparison between the Long-Pulsed Alexandrite Laser and Diode laser:
The study conducted by Toosi et al. (2006) compared Long-Pulsed Alexandrite and Intense Pulsed Light systems (IPL) and Diode
Laser (Toosi et al, 2006) and the study of Handrick and Alster (2001) compared Alexandrite Long-Pulsed and Diode laser (Handrick
and Alster, 2001).
The most common cases of short-term complications include peri-follicular edema and transient erythema. A case of tiny blister
was observed in the Diode group and one case of vesicle production was observed in Alexandrite group. The pain in Alexandrite was
low to moderate and moderate to moderately intense in the diode. However, numerical criteria and a method for measuring pain
were not mentioned and no evidence of persistent complications, such as osteoporosis, was reported.
In addition, Ayatollahi et al. (2019) also compared 755-nm diode laser with conventional 755-nm Alexandrite laser. They assessed
hair reduction by counting hairs per square centimeter, 6 months after the last treatment and also evaluated treatment outcomes by
images, using Physician Global Assessment scale (GAS) and patient satisfaction using visual analogue scale (VAS). They also
measured skin biophysical criteria such as erythema and skin sebum. The results of this study showed significant reduction in both
groups (-35% in Alexandrite laser and -33% in Diode laser (p= 0.85). They didn’t observe any adverse effects in both groups but
subject satisfaction was higher in Alexandrite laser group (Ayatollahi et al., 2019).
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Due to the incomplete report of the data in the study by Handrick, the standard deviation of the data was not measurable, and
therefore meta-analysis was not applicable (Handrick and Alster, 2001). Therefore, the result of the most powerful study, that is the
one conducted by Toosi which had a lot of participants, is considered as the base for the treatment (Toosi etal., 2006). Comparing
the therapeutic effects between the treatment methods after 6 months, no statistically significant difference was found between
these therapeutic methods on the mean reduction in the amount of hair measured: Alexandrite (68.75 ± 16.92%), IPL (66.96 ±
14.74%), Diode (71.71 ± 18.12%),(P = 0.194, F = 1.653)
B. Studies related to the comparison between Nd:YAG and Long-Pulsed Alexandrite Lasers:
The study conducted by Davoudi et al. (2008) compared the Alexandrite Long-Pulsed and Nd:YAG laser (Davoudi et al., 2008) and
the study conducted by Ghaly (2006) compared Long-Pulsed Alexandrite and Nd:YAG laser and IPL (Ghaly, 2006):
Short-term complications included little pain, which was more common in Alexandrite. Pain was observed in 40% of cases of
Alexandrite and 17.5% in Nd:YAG lasers. The pain in Nd:YAG laser and IPL were reported as a feeling of burning and a brief
discomfort, and in Alexandrite laser, it was felt as needle-punching and with high intensity but tolerable. Due to the difference of the
two studies in pain reporting methods, the results did not have the ability of aggregation and integration. No chronic or persistent
symptom, such as scarring or atrophy, was reported by the patient at long term. There was no difference in satisfaction and
acceptance of patients between devices.
The combination of the therapeutic effect through meta-analysis indicated that in the combination of two studies using the
Random Effect Model, the Mean Difference of the two studies was obtained as 16.62 and, in the range, [3.69, 29.55], with statistically
significance and P = 0.01 (figure 1).
Figure 1 Forest plot of comparison between the Long-Pulsed Alexandrite and Nd: YAG Laser
C. The studies related to the comparison between Long-Pulsed Alexandrite Laser and IPL:
Includes the study conducted by Toosi et al. (2005) who compared the Long-Pulsed Alexandrite and Diode laser and the IPL (Toosi
et al., 2006). The study conducted by Ghaly (2008) comparing Long-Pulsed Alexandrite and Nd:YAG laser and IPL) (Ghaly, 2006).
Common short-term complications include little pain, which was most commonly found in Alexandrite. Pain was detected in 40% of
cases of Alexandrite and IPL in 12.5% of cases.
Pain in Nd:YAG lasers and IPLs was reported as a burning sensation and a brief discomfort, and in Alexandrite laser, it was felt as
needle-punching and more intense but tolerable. Due to the difference of the two studies in the pain reporting methods, the results
did not have the ability of aggregation and integration. No chronic or persistent symptoms such as scar or atrophy were reported by
the patient at long term. There was no difference regarding satisfaction and acceptance of patients between devices.
The combination of therapeutic effects of meta-analysis indicated that in the combination of two studies using the Random
Effect Model, the Mean Difference of the two studies in the domain of [-10.50, 39.72] and P = 0.25, was obtained to be 14.61 which
is statistically insignificant (figure 2).
Figure 2 Forest plot of comparison between the Long-Pulsed Alexandrite and Intensive Pulsed Light systems (IPLs)
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In economic evaluation, as there is no significant difference between these two devices in terms of complications and desirability,
the main consideration will be the cost discussion. The incurred costs will include direct costs, productivity costs, and other non-
tangible costs. One rate has been used in order to reduce the costs. For this purpose, we will use the index or the ratio of the cost-
effectiveness ratio of the increase will be used. (Health Information and Quality Authority, 2010; Philips, 2009; Drummond, 2015).
ICER= (𝒄𝒐𝒔𝒕 𝒐𝒇 𝑨−𝒄𝒐𝒔𝒕 𝒐𝒇 𝑩)
(𝒆𝒇𝒇𝒆𝒄𝒕 𝒐𝒇 𝑨−𝒆𝒇𝒇𝒆𝒄𝒕 𝒐𝒇 𝑩) or ICER= 𝒊𝒏𝒄𝒓𝒆𝒎𝒆𝒏𝒕𝒂𝒍 𝒄𝒐𝒔𝒕𝒔
𝒊𝒏𝒄𝒓𝒆𝒎𝒆𝒏𝒕𝒂𝒍 𝒆𝒇𝒇𝒆𝒄𝒕𝒔 (𝒃𝒆𝒏𝒆𝒇𝒊𝒕𝒔)
One of the most obvious principles in the analysis of the cost-effectiveness and its economic analysis is the selection of
appropriate assumptions for analysis. The results of the study indicated that there is no significant statistical difference in side effects
and therapeutic effect between the two groups. Therefore, one of the important assumptions in this analysis was that the
incremental effects were considered a unit in two-by-two analyses. Because in most clinical trials, laser treatment with Alexandrite
had a better short-term outcome, we considered the therapeutic effects of Alexandrite one unit more than the therapeutic effects of
the rest of the devices. The calculations of Table 2 indicate that 3375.12 units of extra charge for the use of the Alexandrite laser
device will increase 1 unit in quality of life. Economically, the Alexandrite Laser has no economic advantage over a diode laser.
Table 2 Incremental cost-effectiveness ratio for the Alexandrite laser device compared to diode laser device
The current value
of the costs
Incremental cost
Incremental effects
The ratio of incremental
efficacy cost
Alexandrite
4928.571
3357.143
1
3357.143
Diode laser
1571.428
1
In Table 3, the ratio of the cost-effective incremental cost for an Alexandrite laser device in comparison to the ND: YAG device
increases costs by 2357.151 units, with an increase of 1 unit of effective lifetime. The economic analysis suggests that the use of
Alexandrite as an alternative for ND: YAG is not economical.
Table 3 Incremental cost-effectiveness ratio for the Alexandrite laser device compared to ND: YAG device
The current
value of the
costs
Incremental
cost
Incremental
effects
The ratio of
incremental efficacy
cost
Alexandrite
4928,571
2357.151
1
2357.151
ND:YAG
2571.42
1
The results presented in Table 4 also indicate the lack of economic justification and the lack of cost effectiveness of replacing the
Alexandrite laser device with the IPL device.
Table 4 Incremental cost-effectiveness ratio for the Alexandrite laser device compared to IPL device
The current
value of the
costs
Incremental
cost
Incremental
effects
The ratio of incremental
efficacy cost
Alexandrite
4928.571
357.151
1
357.151
IPL
4571.42
1
In analyzing sensitivity, since the government's policy was on single rating of the energy, and projections indicate an increase in
the reference exchange rate to 3100, the two rates of 3100 and 3000 were considered as reference rates of analyzing sensitivity
(table 5). Also, given the high probability of lowering interest rates, two rates of 18 and 15 percent were considered as leverages for
changing economic analysis. Four scenarios were proposed for this purpose.
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Table 5 Sensitivity analysis between different scenarios
Scenarios
New cost in
Alexandrite
device
Device ND:YAG
IPL
Diode
1
7473.1026
3896.3832
6935.2748
2384.4736
2
7557.92032
3940.54864
7014.06996
2411.5751
3
7207.0797
3757.8624
6688.1411
2299.4722
4
7283.02999
3797.41048
6758.69847
2323.7403
According to the calculations in the table above, there is no change in economic analysis in the circumstances of the mentioned
scenarios.
4. DISCUSSION AND CONCLUSION
In the current systematic review and meta-analysis, we included only RCTs. During the databases searching, we found other trials
which compared two or more lasers for removing extra hair. They evaluated the different device effect in various areas of the same
subjects. We didn’t include these trials in our systematic review due to the lack of randomization, blinding of participants or
personnel as well as the lack of allocation concealment. The findings of mentioned trials are summarized below:
Khoury et al. (2008) evaluated the safety and efficacy of combining 755- and 1,064-nm wavelengths during 3 treatments at 4- to
6-week intervals for axillary hair removal. Alexandrite laser was used for the left upper axilla quadrants. Nd: YAG laser for left lower
axilla, combination Alexandrite, and Nd: YAG laser for right upper axilla, and diode laser for the right lower quadrant. Eighteen
subjects out of 20 completed the study. The greatest hair reduction was seen with the Alexandrite laser (70.3%) and combination of
Alexandrite and Nd: YAG laser (67.1%). The efficacy of diode laser and Nd: YAG in hair reduction was lesser than the two mentioned
method 59.7% and 47.4% respectively (Khoury et al., 2008).
Paasch et al. (2015) compared the efficacy, tolerability, and subject satisfaction after using 755 nm diode HR mode and scanned
755 nm Alexandrite laser for chest and axillary hair removal on a 47 years old male patient with skin type II and with dark brown
coarse hair. In this study, both systems showed high efficacy in hair reduction with no severe adverse effects (88.8 % 755 nm diode
laser vs. 77.7 % 755 nm Alexandrite laser). However, the authors didn’t report the standard deviation of the data (Paasch et al., 2015).
AL-Dhalimi and Kadhum(2015) compared long-pulsed Alexandrite laser and IPL for face hair removing. He showed that, after six
treatment sessions, IPL-treated sides had longer median hair-free intervals compared with ALX-treated sides. Also, hair reductions in
the IPL group compared with ALX-treated sides at 1, 3, and 6 sessions were statistically significant. Post inflammatory hyper
pigmentation in 10% of patients was present which one of them on the ALX-treated sides and the others on the right side. It was
more severe on the right side and both the patients had skin type IV. Slight stinging and burning sensation at the time of the
treatment were recorded in all patients. Except for hyperpigmentation, the other complications were transient and tolerated by the
patients (Al-Dhalimi and Kadhum, 2015).
Grunewald et al. (2013) compared the efficacy, tolerability, and subject satisfaction of a continuously linear-scanning 808nm
diode laser on right axilla with skin types I–IV of 31 patients with Alexandrite 755nm laser for left axilla hair removal. Mean age of 28
women was 31.2 ± 9.3 years, and 30.3 ± 4.9 years for 3 adult men. They used 6 treatments session at 4-week intervals. Both sides
showed a significant reduction in axillary hair (left side: 72.16%, right side: 71.30%) after the 6th treatment (P<0.05). However, this
reduction amount was not statistically significant when compared to two lasers. Alexandrite was accompanied with more transient
complications including erythema and perifollicular edema (Grunewald et al., 2014).
Hussain et al. (2003) in his study, compared the safety and efficacy of cooled 40-ms Alexandrite laser with fluences of 16 to 24
J/cm2 on hair removal in 144 Asian subjects with skin type III to V. Three treatment for 35 subjects, two treatments for 35 subjects
on 66 anatomic sites, and single treatment for 74 subjects with 124 anatomic sites were done. Hair reduction was 55%, 44% and,
32% respectively at the end of 9 monthsfollowed up. There was no scarring or long-term pigmentary changes in subjects (Hussain et
al., 2003).
Karaca et al. (2012) used the SHR mode IPL system, Alexandrite laser and Nd: YAG laser randomly in three sessions on 25 female
participants with skin types II–IV for hair removal on the cruris and evaluated by a blinded assessor every 6 (mean age 32.85 years)
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weeks and 6 months after the last session. Among 21 subjects that completed the trial, hair reduction was 50% for the IPL system,
53% for Alexandrite and 39% for the Nd: YAG lasers after 6 weeks and 40%, 49% and 34% after 6 months respectively. Pain
according to VAS was lowest in Alexandrite laser (3.90), in comparing to 5.71 for IPL system and 6.95 for Nd: YAG systems. Patient
satisfaction was higher in Alexandrite laser in comparing to IPL and Nd: YAG lasers (37 versus 33 and 27 respectively) (p<0.05).
Erythema and perifollicular edema after some treatment sessions were transient (Karaca et al., 2012).
McGill et al. (2007) in a randomized study, compared 6 treatment session of Alexandrite Laser and IPL system for facial hair
removal in 38 women with polycystic ovary syndrome (PCO) and followed them 1, 3 and 6 months. At the end of treatment
Alexandrite laser showed longer median hair-free intervals in comparing to IPL (7 weeks vs. 2 weeks; P<0.001). Hair reduction was
significantly larger on the Alexandrite side compared to the IPL side at 1, 3 and 6 months (52%, 43% and 46% vs. 21%, 21%, an d
27%; P<0.001 respectively). Patient’s satisfaction according to linear analogue scales (LAS) was significantly higher for Alexandrite
laser than the IPL in three- time period (8.7, 7.8 and 7.7 vs. 5.7, 5.1 and 5.1; P=0.002) (McGill, 2007).
Rao and Goldman (2005) compared three different laser systems at 6- to 8-week intervals on 20 female patients. Alexandrite
laser, diode laser, and Nd:YAG laser, each for three session and rotational treatment consisting of a single session was used for each
patient. At the 3-month follow-up, hair reduction was 59.3± 9.7% in Alexandrite laser, 58.7 ± 7.7% in diode 31.9 ±11.1% for Nd:YAG
laser and 39.8 ± 10.1% in rotational regimens. Tolerability of Alexandrite and diode laser was equal and Nd: YAG laser was
uncomfortable among them. Diode laser was the first device according to patient satisfaction and then Alexandrite laser, rotational
therapy, and Nd: YAG lasers were in the next rank (Raoand Goldman, 2005).
Rogers et al. (1999) in a comparative study on 15 subjects used Alexandrite laser for the right axilla and two treatments with the
topical suspension assisted Nd: YAG laser for the left side. Finally, 13 participants completed the study. The mean percentage hair
reduction after 2 months was 55% following Alexandrite laser and 73% for the Nd: YAG laser-treated regions (p=0.029). After 3
months, the reduction was 19% for Alexandrite and 27% for Nd: YAG laser (P=0.030). Erythema and edema were prevalent in
patients. Side effects were more common in Alexandrite laser (Rogerset al., 1999).
The results of our study showed that, in the field of safety, side effects are minimal and transient. This method is safe considering
the proper treatment and low side effects. Generally short-term transient effects in the diode laser were greater than that of the
Alexandrite, while in the Nd: YAG laser and IPL, they were generally lower than that of the Alexandrite. No serious complications
have been observed in the long term and the methods are not different in this case. There was no difference between the methods
in patient satisfaction. There was no difference in the therapeutic effect of the comparison between long-pulsed Alexandrite laser
with diode laser and IPL, the only significant difference was in the mean of hair loss that was obtained through comparing to the
Long-Pulsed Alexandrite and Nd: YAG lasers where the Alexandrite laser reduced its rate by 16.62% than the Nd: YAG laser.
The results of economic analysis using the cost-effectiveness analysis and sensitivity analysis indicate that, economically, the
Alexandrite laser device has no economic advantage in terms of cost effectiveness compared to other alternative methods. This
analysis has been conducted based on the assumptions and current conditions of the device and technology available on the
Alexandrite laser device. If some changes occur in the therapeutic effects or technology of the device and its final cost, the results of
the analysis will change. In this study, using standard texts and according to the international guidelines, the analysis of cost efficacy
was investigated to estimate the monetary value of therapeutic interventions, costs and therapeutic effects of using Alexandrite laser
device. The results indicated that extra costs for using the Alexandrite laser device is not effective compared to other therapeutic
approaches. In other words, the use of this laser instead of other methods is not economically justifiable. This conclusion is achieved
taking into account the therapeutic effects and economic analysis. We also used a sensitivity analysis to introduce uncertainty effects
on the analysis. The items that can be used to construct the sensitivity leverage are the currency fluctuations of the reference
currency, the fluctuations in the discount rate, the probability fluctuations and the payroll of the workforce. In this analysis, two
factors of exchange rate and interest rate changes as factors affecting economic and sensitivity analyses. In other words, two factors
affecting the analysis, which are the macroeconomic policies of the country, were analyzed Taking into account the government's
economic policies in the coming year and comprehensive analysis in this section, after scenario making, cost efficiency calculations
were re-conducted. Based on the results of this section, potential changes also did not affect the economy of this device. In the end,
the results of the economic analysis indicated that the Alexandrite laser device has no economic advantage in terms of cost
effectiveness than other alternative methods.
Conflict of interest
The authors declare no conflict of interest.
© 2019 Discovery Publication. All Rights Reserved. www.discoveryjournals.org OPEN ACCESS
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Funding
This study was approved by Research Center for Evidence-base Medicine (IRCEBM/1542).
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