An economic evaluation of topical treatments for actinic keratosis.
Actinic keratoses (AK) commonly occur as lesions, in sun-exposed areas. Various treatment modalities exist for their removal. We assessed the cost-effectiveness in 2007 of topical treatments (5-fluorouracil, imiquimod) and photodynamic therapy with methyl aminolevulinate (MAL-PDT) for AK under the perspective of the UK National Health Service (NHS) in England and Wales over two lines of treatment. We used a decision tree analytical approach. Efficacy data were taken from published trial literature for two investigator-assessed outcomes: 'complete clinical response' and 'excellent cosmetic outcome'. MAL-PDT at first line followed by various second-line treatments provided the greatest probability of complete clinical response (91.7%), but MAL-PDT at first line followed by further MAL-PDT as the second-line treatment provided the greatest probability of excellent cosmetic outcome (73.6%). The cost of MAL-PDT was 437 pounds sterling after two lines of treatment if MAL-PDT was that second-line treatment or 418 pounds sterling if various treatments were offered at second line. The probabilistic analysis produced consistent results. Based on this model, the costs and effectiveness of MAL-PDT in the UK NHS compare well with other treatments for AK.
Muston
Dominic
D
Heron Evidence Development Ltd, Stopsley, Luton, UK.
Downs
Anthony
A
Rives
Vincent
V
D000279:Administration, Cutaneous; D000622:Aminolevulinic Acid / Q000031:analogs & derivatives / Q000191:economics / Q000627:therapeutic use; D000634:Aminoquinolines / Q000191:economics / Q000627:therapeutic use; D000970:Antineoplastic Agents / Q000191:economics* / Q000627:therapeutic use; D003362:Cost-Benefit Analysis; D005472:Fluorouracil / Q000191:economics / Q000627:therapeutic use; D006801:Humans; D000077271:Imiquimod; D055623:Keratosis, Actinic / Q000191:economics* / Q000473:pathology / Q000628:therapy*; D018803:Models, Economic; D010778:Photochemotherapy / Q000191:economics*; D017319:Photosensitizing Agents / Q000191:economics* / Q000627:therapeutic use; D016896:Treatment Outcome; D006113:United Kingdom
D000634:Aminoquinolines; D000970:Antineoplastic Agents; D017319:Photosensitizing Agents; C475457:methyl 5-aminolevulinate; D000622:Aminolevulinic Acid; D000077271:Imiquimod; D005472:Fluorouracil