title: Evaluation of Resource Utilization and Treatment Patterns in Patients with Actinic Keratosis in the United States.
abstract: OBJECTIVE
  To compare health care resource utilization and treatment patterns between patients with actinic keratosis (AK) treated with ingenol mebutate gel (IngMeb) and those treated with other field-directed AK therapies.
  
  
  METHODS
  A retrospective, propensity-score-matched, cohort study compared refill/repeat and adding-on/switching patterns and outpatient visits and prescriptions (health care resource utilization) over 6 months in patients receiving IngMeb versus those receiving imiquimod, 5-fluorouracil, diclofenac sodium, and methyl aminolevulinate or aminolevulinic acid photodynamic therapy (MAL/ALA-PDT).
  
  
  RESULTS
  The final sample analyzed included four matched treatment cohort pairs (IngMeb and comparator; n = 790-971 per treatment arm). Refill rates were similar except for imiquimod (15% vs. 9% for imiquimod and IngMeb, respectively; P < 0.05). MAL/ALA-PDT treatment repetition rates were higher than IngMeb refill rates (20% vs. 10%; P < 0.05). Topical agent add-on/switch rates were comparable. PDT had higher switch rates than did IngMeb (5% vs. 2%; P < 0.05). The IngMeb cohort had a significantly lower proportion of patients with at least one AK-related outpatient visit during the 6-month follow-up than did any other cohort: versus imiquimod (50% vs. 66%; P < 0.0001), versus 5-fluorouracil (50% vs. 69%; P < 0.0001), versus diclofenac sodium (51% vs. 56%; P = 0.034), and versus MAL/ALA-PDT (50% vs. 100%; P < 0.0001). There were significantly fewer AK-related prescriptions among patients receiving IngMeb than among patients in other cohorts.
  
  
  CONCLUSIONS
  Results based on the first 6 months after treatment initiation suggested that most field-directed AK therapies had clinically comparable treatment patterns except imiquimod, which was associated with higher refill rates, and PDT, which was associated with significantly more frequent treatment sessions and higher switching rates. IngMeb was also associated with significantly fewer outpatient visits than were other field-directed therapies.
authors.affiliation: Center for Outcomes Research and the Department of Medicine, University of Illinois College of Medicine at Peoria, Peoria, IL, USA; Department of Pharmacy Systems, Outcomes and Policy, University of Illinois at Chicago College of Pharmacy, Chicago, IL, USA. Electronic address: cva@uic.edu.
authors.forename: Carl V
authors.initials: CV
authors.lastname: Asche
authors.affiliation: LEO Pharma, Inc., Parsippany, NJ, USA.
authors.forename: Panagiotis
authors.initials: P
authors.lastname: Zografos
authors.affiliation: LEO Pharma A/S, Ballerup, DK.
authors.forename: Jenny M
authors.initials: JM
authors.lastname: Norlin
authors.affiliation: LEO Pharma, Inc., Parsippany, NJ, USA.
authors.forename: Bill
authors.initials: B
authors.lastname: Urbanek
authors.affiliation: LEO Pharma, Inc., Parsippany, NJ, USA.
authors.forename: Carl
authors.initials: C
authors.lastname: Mamay
authors.affiliation: IMS Health, RWE-HEOR Plymouth Meeting, PA, USA.
authors.forename: Charles
authors.initials: C
authors.lastname: Makin
authors.affiliation: LEO Pharma A/S, Ballerup, DK.
authors.forename: Sandra
authors.initials: S
authors.lastname: Erntoft
authors.affiliation: IMS Health, RWE-HEOR Plymouth Meeting, PA, USA.
authors.forename: Chi-Chang
authors.initials: CC
authors.lastname: Chen
authors.affiliation: IMS Health, RWE-HEOR Plymouth Meeting, PA, USA.
authors.forename: Dionne M
authors.initials: DM
authors.lastname: Hines
authors.affiliation: Department of Dermatology, SUNY Downstate, Brooklyn, NY, USA; Long Island Skin Cancer and Dermatologic Surgery, a division of ProHealthCare Associates, Smithtown, NY, USA.
authors.forename: Daniel
authors.initials: D
authors.lastname: Mark Siegel
mesh_terms: D000368:Aged; D000553:Ambulatory Care / Q000639:trends; D003131:Combined Modality Therapy; D003879:Dermatologic Agents / Q000191:economics / Q000627:therapeutic use*; D004224:Diterpenes / Q000191:economics / Q000627:therapeutic use*; D016527:Drug Costs; D011307:Drug Prescriptions; D057915:Drug Substitution / Q000639:trends; D004359:Drug Therapy, Combination; D005260:Female; D006295:Health Resources / Q000191:economics / Q000706:statistics & numerical data / Q000639:trends*; D006801:Humans; D053208:Kaplan-Meier Estimate; D055623:Keratosis, Actinic / Q000175:diagnosis / Q000188:drug therapy* / Q000191:economics; D008297:Male; D008875:Middle Aged; D010818:Practice Patterns, Physicians' / Q000191:economics / Q000639:trends*; D057216:Propensity Score; D016016:Proportional Hazards Models; D012189:Retrospective Studies; D013997:Time Factors; D016896:Treatment Outcome; D014481:United States
chemical_list: C486592:3-ingenyl angelate; D003879:Dermatologic Agents; D004224:Diterpenes
keywords: actinic keratosis; health care resource utilization; treatment patterns