title: Cost-utility of first-line actinic keratosis treatments in Finland.
abstract: BACKGROUND
  Cost-utility assessment of first-line actinic keratosis (AK) treatments for max 25 cm2 AK field.
  
  
  METHODS
  A probabilistic, 2-year decision tree model was used to assess costs, quality-adjusted life-years (QALY), incremental cost-effectiveness ratio (ICER), cost-effectiveness efficiency frontier, cost-effectiveness acceptability frontier (CEAF), and expected value of perfect information (EVPI) of AK treatments from the Finnish health care payer perspective with 3% discounting per annum. In the model, the first-line AK treatment resulted in complete clearance (CC) or non-CC with or without local skin responses (LSR), or AK recurrence. Non-CC AK was treated with methyl aminolevulinate+photodynamic therapy (MAL+PDT), and AK recurrence was retreated with the previous effective treatment. Costs included primary and secondary health care, outpatient drugs, and LSR management. QALYs were assessed with the EuroQol (EQ-5D-3L). Result robustness was assessed with sensitivity analyses.
  
  
  RESULTS
  The mean simulated per patient QALYs (costs) were 1.526 (€982) for MAL+PDT, 1.524 (€794) for ingenol mebutate gel (IngMeb) 0.015% (3 days), 1.522 (€869) for IngMeb 0.05% (2 days), 1.520 (€1062) for diclofenac 3% (12 weeks), 1.518 (€885) for imiquimod 3.75% (6 weeks), 1.517 (€781) for imiquimod 5% (4/8 weeks), and 1.514 (€1114) for cryosurgery when treating AK affecting any body part. IngMeb 0.015% was less costly and more effective (dominating) than other AK treatments indicated for face and scalp area with the exception of imiquimod 5% for which the ICER was estimated at €1933/QALY gained and MAL+PDT, which had an ICER of €82,607/QALY gained against IngMeb 0.015%. With willingness-to-pay €2526-18,809/QALY gained, IngMeb 0.015% had >50% probability for cost-effectiveness on the CEAF. IngMeb 0.05% dominated AK treatments indicated for trunk and extremities. EVPIs for face and scalp (trunk and extremities) analyses were €26 (€0), €86 (€58), and €250 (€169) per patient with the willingness-to-pay of €0, €15,000, and €30,000 per QALY gained, respectively.
  
  
  CONCLUSIONS
  IngMebs were cost-effective AK treatments in Finland.
  
  
  BACKGROUND
  LEO Pharma.
authors.affiliation: ESiOR Oy, Kuopio, Finland, erkki.soini@esior.fi.
authors.forename: Erkki J
authors.initials: EJ
authors.lastname: Soini
authors.forename: Taru
authors.initials: T
authors.lastname: Hallinen
authors.forename: Anna-Leena
authors.initials: AL
authors.lastname: Sokka
authors.forename: Kari
authors.initials: K
authors.lastname: Saarinen
mesh_terms: D003362:Cost-Benefit Analysis / Q000379:methods; D003879:Dermatologic Agents / Q000191:economics* / Q000627:therapeutic use*; D004224:Diterpenes / Q000191:economics / Q000627:therapeutic use; D005387:Finland; D017048:Health Care Costs / Q000706:statistics & numerical data*; D006801:Humans; D055623:Keratosis, Actinic / Q000191:economics* / Q000628:therapy*; D019057:Quality-Adjusted Life Years; D016896:Treatment Outcome
chemical_list: C486592:3-ingenyl angelate; D003879:Dermatologic Agents; D004224:Diterpenes