Pharmacoeconomic analysis of the treatment of multiple actinic keratoses.
Actinic keratosis (AK) is common and lesions may progress to squamous cell carcinoma. The choice of therapy depends mainly on 2 factors: the efficacy of therapeutic options and the number of lesions present. Cryotherapy alone is suitable for treating a few lesions, whereas topical medications, photodynamic therapy (PDT) with 5-aminolevulinic acid (ALA), or either in combination with cryotherapy are appropriate for treating multiple (>15) lesions. When combinations are necessary, the total cost to treat multiple AKs to 100% clearance becomes important. This report provides a simple pharmacoeconomic analysis of 4 FDA-cleared therapies (imiquimod, diclofenac, 5-fluorouacil [5-FU], and ALA PDT) for AK given in combination with cryotherapy. This analysis assumes standard costs of procedures and office visits (based on April 2007 reimbursement data) and 2 treatment courses (medications: imiquimod, diclofenac, 5-FU) or sessions (ALA PDT) of each modality followed by cryotherapy to 100% clearance. The total cost of each combination is $725.17 for ALA PDT, $845.07 for diclofenac, $942.13 for 5-FU, and $1,473.39 for imiquimod. When phase III trial efficacies of the 4 modalities are considered, the actual cost of using imiquimod or diclofenac increases because additional treatments may be required. Among these 4 FDA-cleared therapies for multiple AK lesions, ALA PDT is the least expensive treatment and imiquimod is the most expensive treatment under the stated assumptions.
Gold
Michael H
MH
Gold Skin Care Center, Tennessee Clinical Research Center, Nashville 37215, USA. goldskin@goldskincare.com
D000622:Aminolevulinic Acid / Q000191:economics / Q000627:therapeutic use; D000634:Aminoquinolines / Q000191:economics / Q000627:therapeutic use; D017326:Clinical Trials, Phase III as Topic; D003131:Combined Modality Therapy; D017679:Cryotherapy / Q000191:economics / Q000379:methods*; D004008:Diclofenac / Q000191:economics / Q000627:therapeutic use; D005472:Fluorouracil / Q000191:economics / Q000627:therapeutic use; D006801:Humans; D000077271:Imiquimod; D007642:Keratosis / Q000503:physiopathology / Q000628:therapy*; D010778:Photochemotherapy / Q000191:economics / Q000379:methods*; D016896:Treatment Outcome
D000634:Aminoquinolines; D004008:Diclofenac; D000622:Aminolevulinic Acid; D000077271:Imiquimod; D005472:Fluorouracil