title: The cost-effectiveness of 5-FU-SA in the treatment of actinic keratoses of the face and scalp in the UK secondary care setting.
abstract: OBJECTIVE
  The objective of this analysis was to estimate the relative cost-effectiveness of Actikerall1(5-FU-SA) vs cryotherapy in a secondary care setting in the UK, for lesion-directed treatment in patients with actinic keratoses (AK) of the face and scalp.
  
  
  METHODS
  The model was a simple decision tree, with a 6-month time horizon. The perspective was that of the UK National Health Service (NHS). Modeled treatment effects included reported per-patient histological clearance and recurrence rates. Cost inputs comprised professional consultation time and cost of medication. Health-related utility estimation followed previously published methodology. Adverse events were not modeled. The key data and model structural assumptions followed expected UK practice. One-way and probabilistic sensitivity analyses were conducted to assess structural and parameter uncertainty.
  
  
  RESULTS
  5-FU-SA was found to be less costly (-£204) and more effective (+0.001 QALY) in base case and sensitivity analyses. In the probabilistic analysis there was 100% probability of being cost-effective over cryotherapy at £20,000 willingness to pay. Cost of professional time was a key driver of the model outcome. 5-FU-SA remained dominant across a range of scenario analyses, including exploration of assumptions around setting of care.
  
  
  CONCLUSIONS
  The time horizon of the analysis was short and data were not extrapolated beyond the duration of the clinical trial; however, this approach is consistent with likely follow-up of an AK patient. The clinical outcomes observed in the trial were based on a large proportion of cryotherapy patients undergoing an additional cycle of treatment; this may not occur or be required in an experienced secondary care setting.
  
  
  CONCLUSIONS
  5-FU-SA could be considered as a cost-effective choice for treatment of AK lesions of the face and scalp in secondary and mixed care settings in the UK. Use of 5-FU-SA in patients who would otherwise be managed with cryotherapy has the potential to result in cost savings.
authors.affiliation: a IMS Health Ltd. , London , UK.
authors.forename: Radek
authors.initials: R
authors.lastname: Wojcik
authors.affiliation: a IMS Health Ltd. , London , UK.
authors.forename: Julia
authors.initials: J
authors.lastname: Lowin
authors.affiliation: b Almirall S.A. - Global Medical Affairs , Barcelona , Catalunya , Spain.
authors.forename: David
authors.initials: D
authors.lastname: Vilardell
authors.affiliation: b Almirall S.A. - Global Medical Affairs , Barcelona , Catalunya , Spain.
authors.forename: Silvia
authors.initials: S
authors.lastname: Maeso
authors.affiliation: b Almirall S.A. - Global Medical Affairs , Barcelona , Catalunya , Spain.
authors.forename: Leonardo
authors.initials: L
authors.lastname: Ruiz
authors.affiliation: c Manchester Royal Infirmary - Dermatology , Manchester , UK.
authors.forename: John T
authors.initials: JT
authors.lastname: Lear
authors.affiliation: d Stirling Community Hospital - Forth Valley Dermatology Centre , Stirling , UK.
authors.forename: Colin
authors.initials: C
authors.lastname: Morton
mesh_terms: D000368:Aged; D003362:Cost-Benefit Analysis / Q000379:methods; D005145:Face / Q000503:physiopathology*; D006801:Humans; D007641:Keratolytic Agents / Q000008:administration & dosage / Q000191:economics*; D055623:Keratosis, Actinic / Q000188:drug therapy*; D008297:Male; D020156:Salicylic Acid / Q000008:administration & dosage / Q000191:economics*; D012535:Scalp / Q000503:physiopathology*; D006113:United Kingdom
chemical_list: D007641:Keratolytic Agents; D020156:Salicylic Acid
keywords: 5-FU-SA; Actinic keratosis; cost-effectiveness; cryotherapy; secondary care