title: A cost-utility analysis of ingenol mebutate gel for the treatment of actinic keratosis: a Scottish perspective.
abstract: BACKGROUND
  Actinic keratosis (AK) is a UV-induced, pre-malignant skin condition that is common in adults over 60 years of age with fair skin in Scotland. The most commonly prescribed first-line treatment for AK in Scotland is currently diclofenac gel (3 %). Ingenol mebutate gel is a recently developed topical therapy available in two strengths for the treatment of AK lesions on the face and scalp (150 mcg/g once daily for 3 consecutive days) or trunk and extremities (500 mcg/g once daily for 2 consecutive days).
  
  
  OBJECTIVE
  To compare the cost-effectiveness of two strengths of ingenol mebutate gel developed to treat AK lesions on the face and scalp (150 mcg/g once daily for 3 consecutive days) or trunk and extremities (500 mcg/g once daily for 2 consecutive days) with other first-line AK therapies including diclofenac gel, 5-FU, 5-FU/salicylic acid, and cryotherapy for the first-line treatment of AK in adult patients, from the perspective of the National Health Service (NHS) in Scotland.
  
  
  METHODS
  A cost-utility analysis was conducted using a decision-tree approach to calculate the costs and benefits of different treatment strategies for AK on the face and scalp or trunk and limbs over a 12-month time horizon. Data on the relative efficacy of treatments were obtained from a systematic literature review and meta-analysis. Utility scores and resource-use data were obtained from published sources.
  
  
  RESULTS
  Over 12 months, ingenol mebutate 150 mcg/g gel and 500 mcg/g gel were cost-effective compared with the most commonly used topical therapy in Scotland, diclofenac (3 %) gel, at a willingness-to-pay threshold of £20,000 per QALY, with a minimal additional cost of £43 and £105, respectively per QALY gained.
  
  
  CONCLUSIONS
  Ingenol mebutate gel is a cost-effective therapy for the first-line treatment of AK from a Scottish NHS perspective.
authors: Tolley Health Economics, Buxton, Derbyshire, UK.
authors: Keith
authors: K
authors: Tolley
authors: Department of Dermatology, Vale of Leven Hospital, Alexandria, Dunbartonshire, UK.
authors: Danny
authors: D
authors: Kemmett
authors: LEO Pharma, Hurley, Berkshire, UK.
authors: Signe
authors: S
authors: Thybo
authors: LEO Pharma, Hurley, Berkshire, UK.
authors: Ruth
authors: R
authors: Nasr
authors: Abacus International, Bicester, Oxfordshire, UK. hsmethurst@dresourcesgroup.com.
authors: Helen
authors: H
authors: Smethurst
mesh_terms: D003362:Cost-Benefit Analysis; D017679:Cryotherapy / Q000191:economics / Q000379:methods; D004008:Diclofenac / Q000191:economics / Q000627:therapeutic use; D004224:Diterpenes / Q000008:administration & dosage / Q000009:adverse effects / Q000191:economics* / Q000627:therapeutic use*; D004305:Dose-Response Relationship, Drug; D005472:Fluorouracil / Q000191:economics / Q000627:therapeutic use; D006801:Humans; D007641:Keratolytic Agents / Q000008:administration & dosage / Q000009:adverse effects / Q000191:economics* / Q000627:therapeutic use*; D055623:Keratosis, Actinic / Q000188:drug therapy*; D017059:Models, Econometric; D019057:Quality-Adjusted Life Years; D012008:Recurrence; D020156:Salicylic Acid / Q000191:economics / Q000627:therapeutic use; D012606:Scotland; D016896:Treatment Outcome
chemical_list: C486592:3-ingenyl angelate; D004224:Diterpenes; D007641:Keratolytic Agents; D004008:Diclofenac; D020156:Salicylic Acid; D005472:Fluorouracil
keywords: Actinic keratosis; Cost-effectiveness; ICER; Ingenol mebutate gel