Economic evaluation of methyl aminolaevulinate-based photodynamic therapy in the management of actinic keratosis and basal cell carcinoma.
BACKGROUND
Various effective therapeutic options are currently available for the treatment of actinic keratosis (AK) and basal cell carcinoma (BCC), but none is perfect. Poor cosmesis resulting from surgical procedures and skin irritation induced by topical agents remain significant problems.


OBJECTIVE
To evaluate the cost-effectiveness of a recent approach, methyl aminolaevulinate-based photodynamic therapy (MAL-PDT; Metvix; Galderma, Lausanne, Switzerland) in AK and BCC.


METHODS
A medical decision tree was developed for simulation of all possible outcomes associated with the medical decision to apply MAL-PDT or a comparator. The time horizon was 1 year for AK and 5 years for BCC. The comparators were cryotherapy in AK and excision surgery in BCC. Clinical data for the model were obtained from the literature. Data on medical management resulted from a Delphi panel performed among 12 Belgian dermatologists. Based on the model, the cost per full responder was calculated, whereby a responder was defined as a patient with all lesions clinically responding and showing an excellent cosmetic result.


RESULTS
MAL-PDT is a more expensive treatment compared with cryotherapy for AK. However, the cost per full responder is comparable with cryotherapy (euro363 and euro379, respectively). Incremental cost per extra full responder is euro401. Incremental cost per full responder is euro469 for nodular BCC and euro251 for superficial BCC, both compared with excision surgery.


CONCLUSIONS
The results suggest that MAL-PDT is a cost-effective intervention in AK taking a 1-year time horizon, if society is willing to pay euro1.50 per day of response, and that MAL-PDT is better value for money than excision in BCC, taking a 5-year time horizon.
Caekelbergh
K
K
HEDM (Health Economics and Disease Management), Brussels, Belgium.
Annemans
L
L
Lambert
J
J
Roelandts
R
R
D000622:Aminolevulinic Acid / Q000031:analogs & derivatives* / Q000191:economics / Q000627:therapeutic use; D001530:Belgium; D002280:Basal Cell Carcinoma / Q000188:drug therapy / Q000191:economics* / Q000601:surgery; D003362:Cost-Benefit Analysis; D003452:Cryosurgery / Q000191:economics; D003657:Decision Making; D016527:Drug Costs / Q000706:statistics & numerical data; D017048:Health Care Costs / Q000706:statistics & numerical data; D006801:Humans; D007642:Keratosis / Q000188:drug therapy / Q000191:economics* / Q000601:surgery; D017059:Models, Econometric; D010778:Photochemotherapy / Q000191:economics* / Q000379:methods; D017319:Photosensitizing Agents / Q000191:economics / Q000627:therapeutic use; D012878:Skin Neoplasms / Q000188:drug therapy / Q000191:economics* / Q000601:surgery
D017319:Photosensitizing Agents; C475457:methyl 5-aminolevulinate; D000622:Aminolevulinic Acid