Edward C F Wilson1. 1. Health Economics Group, Faculty of Health, University of East Anglia, Norwich, UK. ed.wilson@uea.ac.uk
Abstract
BACKGROUND: Actinic keratosis (AK) is caused by chronic exposure to UV radiation (sunlight). First-line treatments are cryosurgery, topical 5-fluorouracil (5-FU) and topical diclofenac. Where these are contraindicated or less appropriate, alternatives are imiquimod and photodynamic therapy (PDT). OBJECTIVE: To compare the cost effectiveness of imiquimod and methyl aminolevulinate-based PDT (MAL-PDT) from the perspective of the UK NHS. METHODS: A decision tree model was populated with data from a literature review and used to estimate costs and QALYs gained and incremental cost effectiveness over 1 year. The model simulated patients who were in secondary care, who had four to nine AK lesions, and for whom cryosurgery, 5-FU and diclofenac were contraindicated or considered less appropriate. RESULTS: Over 1 year, imiquimod cost £174 less than MAL-PDT (year 2006 values) but resulted in 0.005 fewer QALYs gained. The incremental cost-effectiveness ratio (ICER) of MAL-PDT over imiquimod was £34,576. In the probabilistic sensitivity analysis, there was a 75% probability that imiquimod was cost effective compared with MAL-PDT at a threshold of £20,000 per QALY gained, falling to 73% at £30,000. CONCLUSIONS: Imiquimod may be the more cost-effective treatment at conventional cost-effectiveness thresholds. A direct head-to-head study of MAL-PDT versus imiquimod is required to reduce uncertainty.
BACKGROUND:Actinic keratosis (AK) is caused by chronic exposure to UV radiation (sunlight). First-line treatments are cryosurgery, topical 5-fluorouracil (5-FU) and topical diclofenac. Where these are contraindicated or less appropriate, alternatives are imiquimod and photodynamic therapy (PDT). OBJECTIVE: To compare the cost effectiveness of imiquimod and methyl aminolevulinate-based PDT (MAL-PDT) from the perspective of the UK NHS. METHODS: A decision tree model was populated with data from a literature review and used to estimate costs and QALYs gained and incremental cost effectiveness over 1 year. The model simulated patients who were in secondary care, who had four to nine AK lesions, and for whom cryosurgery, 5-FU and diclofenac were contraindicated or considered less appropriate. RESULTS: Over 1 year, imiquimod cost £174 less than MAL-PDT (year 2006 values) but resulted in 0.005 fewer QALYs gained. The incremental cost-effectiveness ratio (ICER) of MAL-PDT over imiquimod was £34,576. In the probabilistic sensitivity analysis, there was a 75% probability that imiquimod was cost effective compared with MAL-PDT at a threshold of £20,000 per QALY gained, falling to 73% at £30,000. CONCLUSIONS:Imiquimod may be the more cost-effective treatment at conventional cost-effectiveness thresholds. A direct head-to-head study of MAL-PDT versus imiquimod is required to reduce uncertainty.
Authors: Colin A Morton; S B Brown; S Collins; S Ibbotson; H Jenkinson; H Kurwa; K Langmack; K McKenna; H Moseley; A D Pearse; M Stringer; D K Taylor; G Wong; L E Rhodes Journal: Br J Dermatol Date: 2002-04 Impact factor: 9.302
Authors: R M Szeimies; S Karrer; S Radakovic-Fijan; A Tanew; P G Calzavara-Pinton; C Zane; A Sidoroff; M Hempel; J Ulrich; T Proebstle; H Meffert; M Mulder; D Salomon; H C Dittmar; J W Bauer; K Kernland; L Braathen Journal: J Am Acad Dermatol Date: 2002-08 Impact factor: 11.527
Authors: W G Philipp-Dormston; K Müller; B Novak; K Strömer; C Termeer; U Hammann; J W Glutsch; G Krähn-Senftleben; H Lübbert; M Koller; R M Szeimies Journal: J Eur Acad Dermatol Venereol Date: 2018-01-12 Impact factor: 6.166
Authors: M H E Jansen; J P H M Kessels; I Merks; P J Nelemans; N W J Kelleners-Smeets; K Mosterd; B A B Essers Journal: Br J Dermatol Date: 2020-02-19 Impact factor: 9.302