Cost-effectiveness analysis of topical treatments for actinic keratosis in the perspective of the Italian health care system

Actinic keratosis (AK) is the most common cutaneous malignant neoplasm and its prevalence continues to increase. According to the most recent findings, AK is currently considered the initial stage, in situ, of squamous cell carcinoma. Field-directed therapies for AKs are the preferred treatment sinc...

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Published inGiornale italiano di dermatologia e venereologia Vol. 145; no. 5; p. 573
Main Authors Colombo, G L, Chimenti, S, Di Matteo, S, Fargnoli, M C, Frascione, P, Silipo, V, Peris, K
Format Journal Article
LanguageEnglish
Published Italy 01.10.2010
Subjects
Administration, Topical
Aminolevulinic Acid - analogs & derivatives
Aminolevulinic Acid - economics
Aminolevulinic Acid - therapeutic use
Aminoquinolines - economics
Aminoquinolines - therapeutic use
Cost-Benefit Analysis
Decision Trees
Delivery of Health Care
Diclofenac - economics
Diclofenac - therapeutic use
Health Care Costs
Humans
Italy
Keratosis, Actinic - drug therapy
Keratosis, Actinic - economics
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Summary:Actinic keratosis (AK) is the most common cutaneous malignant neoplasm and its prevalence continues to increase. According to the most recent findings, AK is currently considered the initial stage, in situ, of squamous cell carcinoma. Field-directed therapies for AKs are the preferred treatment since they have the advantage to clear the clinically visible lesions and also subclinical lesions within the cancerous field. We assessed the cost-effectiveness of topical treatments for AKs including 3% diclofenac in 2.5% hyaluronic acid (HA) gel, imiquimod 5% cream and photodynamic therapy with methyl aminolevulinate (MAL-PDT) in the perspective of the Italian Health Care System (SSN). We used a decision tree analytical approach and efficacy data were drawn from published clinical trials. Cost was evaluated from the SSN perspective during a time horizon of 3 months. A responder was defined as a patient with all lesions clinically cleared and showing an excellent cosmetic result. Based on the applied model, the cost per complete responder was calculated. Diclofenac 3% in HA was less expensive (Euro 256) than MAL-PDT (Euro 320) and imiquimod (Euro 342). Effectiveness was similar and better for diclofenac 3% in HA and MAL-PDT (0.813%) in comparison to 0.734% of imiquimod, respectively. The one-way and probabilistic sensitivity analyses confirmed the results of base case scenario. Based on this cost-effectiveness model, diclofenac 3% in HA can be considered the treatment of choice for AK lesions and surrounding field under a pharmacoeconomic point of view.
ISSN:0392-0488