title: Cost-effectiveness of topical imiquimod and fluorouracil vs. photodynamic therapy for treatment of superficial basal-cell carcinoma.
abstract: BACKGROUND
  A recent noninferiority randomized trial showed that in terms of clinical effectiveness imiquimod was superior and topical fluorouracil noninferior to methylaminolaevulinate photodynamic therapy (MAL-PDT) for treatment of superficial basal-cell carcinoma (sBCC). Although it was expected that MAL-PDT would be more costly than either cream, a full cost-effectiveness analysis is necessary to determine the balance between effectiveness and costs.
  
  
  OBJECTIVE
  To determine whether imiquimod or topical fluorouracil are cost-effective treatments for sBCC compared with MAL-PDT.
  
  
  METHODS
  An economic evaluation was performed from a healthcare perspective. Data on resource use and costs were collected alongside the randomized clinical trial. The incremental cost-effectiveness ratio was expressed as the incremental costs per additional patient free of tumour recurrence.
  
  
  RESULTS
  At 12 months follow-up, the total mean costs for MAL-PDT were €680, for imiquimod cream €526 and for topical fluorouracil cream €388. Both imiquimod and topical fluorouracil were cost-effective treatments compared with MAL-PDT. Comparing costs and effectiveness of both creams led to a incremental investment of €4451 to achieve an additional patient free of tumour recurrence. The acceptability curve showed that, for a threshold value of €4451, the probability of imiquimod being more cost-effective than topical fluorouracil was 50%.
  
  
  CONCLUSIONS
  Based on the 12 months follow-up results, imiquimod and topical fluorouracil cream are more cost-effective than MAL-PDT for treatment of sBCC. Hence, substituting MAL-PDT with either imiquimod or topical fluorouracil results in cost savings; these savings will be larger for topical fluorouracil. Long-term follow-up effectiveness data are necessary to confirm the cost-effectiveness of imiquimod vs. topical 5-fluorouracil cream.
authors.affiliation: Department of Dermatology, Maastricht University Medical Centre, P.O. Box 5800, 6202, AZ Maastricht, the Netherlands; Grow Research Institute for Oncology and Developmental Biology, Maastricht University, Maastricht, the Netherlands.
authors.forename: A H M M
authors.initials: AH
authors.lastname: Arits
authors.forename: E
authors.initials: E
authors.lastname: Spoorenberg
authors.forename: K
authors.initials: K
authors.lastname: Mosterd
authors.forename: P
authors.initials: P
authors.lastname: Nelemans
authors.forename: N W J
authors.initials: NW
authors.lastname: Kelleners-Smeets
authors.forename: B A B
authors.initials: BA
authors.lastname: Essers
mesh_terms: D000279:Administration, Cutaneous; D000622:Aminolevulinic Acid / Q000031:analogs & derivatives / Q000191:economics / Q000627:therapeutic use; D000634:Aminoquinolines / Q000008:administration & dosage; D000971:Antineoplastic Combined Chemotherapy Protocols / Q000191:economics / Q000627:therapeutic use*; D002280:Basal Cell Carcinoma / Q000188:drug therapy* / Q000191:economics; D017046:Cost Savings; D003362:Cost-Benefit Analysis; D005472:Fluorouracil / Q000008:administration & dosage; D005500:Follow-Up Studies; D006801:Humans; D000077271:Imiquimod; D010778:Photochemotherapy / Q000191:economics* / Q000379:methods; D017319:Photosensitizing Agents / Q000191:economics / Q000627:therapeutic use; D012878:Skin Neoplasms / Q000188:drug therapy* / Q000191:economics
chemical_list: D000634:Aminoquinolines; D017319:Photosensitizing Agents; C475457:methyl 5-aminolevulinate; D000622:Aminolevulinic Acid; D000077271:Imiquimod; D005472:Fluorouracil