Efu para QA

Journal Scan / Research · February 05, 2020

Cost-Effectiveness Analysis of Topical 5-Fluorouracil vs Imiquimod vs Ingenol Mebutate vs Methylaminolevulinate Conventional Photodynamic Therapy for the Treatment of Actinic Keratosis in the Head and Neck Area

The British Journal of Dermatology

TAKE-HOME MESSAGE

• In this randomized prospective trial, 624 patients with ≥5 actinic keratoses (AKs) were treated with either 5% 5-fluorouracil (5-FU), 5% imiquimod (IMQ), 0.015% ingenol mebutate (IM), or methylaminolevulinate photodynamic therapy (MAL-PDT). Response was monitored at 3 months and 12 months post-treatment. Treatment success was defined as ≥75% lesion reduction. At 12 months, 74.7% of patients treated with 5-FU achieved treatment success, compared with 53.9% for IMQ, 28.9% for IM, and 37.7% for MAL-PDT. Not only was 5-FU the most effective at treating AKs, it was also significantly less expensive compared with other treatments (total mean cost: €433 for 5-FU, €728 for IMQ, €775 for IM, and €1621 for MAL-PDT).

• While the cost-effectiveness of 5-FU was superior, this must be balanced against ease of treatment and patient preference when selecting therapy.

– Caitlyn T. Reed, MD

Abstract

BACKGROUND

Actinic keratosis (AK) is a common premalignant skin condition and might have the ability to progress into a squamous cell carcinoma (SCC). Due to the high incidence of AK, treatment of this disease significantly impacts healthcare spending.

OBJECTIVES

To determine which commonly prescribed field-directed treatment is the most cost-effective, when comparing 5% 5-fluorouracil (5-FU), 5% imiquimod (IMQ), 0.015% ingenol mebutate (IM), and methylaminolevulinate photodynamic therapy (MAL-PDT) for AK in the head and neck region.

METHODS

We performed an economic evaluation from a healthcare perspective. Data were collected alongside a single-blinded, prospective, multicentre randomized controlled trial with 624 participants in the Netherlands. The outcome measure was expressed in the incremental cost-effectiveness ratio (ICER), which is the incremental costs per additional patient with ≥75% lesion reduction compared to baseline.

RESULTS

The trial showed that 5-FU was the most effective field-treatment for AK in the head and neck region. Twelve months post-treatment, the total mean costs for 5-FU were significantly lower (€433), compared to €728, €775 and €1621 for IMQ, IM and MAL-PDT, respectively. The results showed that 5-FU was a dominant cost-effective (more effective and less expensive) treatment compared to the other treatments, 12 months post-treatment.

CONCLUSIONS

Based on these results, we consider 5% 5-FU cream as first choice treatment option for multiple AK in the head and neck area.

The British Journal of Dermatology

A Trial-Based Cost-Effectiveness Analysis of Topical 5-Fluorouracil vs Imiquimod vs Ingenol Mebutate vs Methylaminolevulinate Conventional Photodynamic Therapy for the Treatment of Actinic Keratosis in the Head and Neck Area Performed in the Netherlands

Br J Dermatol 2020 Jan 21;[EPub Ahead of Print], MHE Jansen, JPHM Kessels, I Merks, PJ Nelemans, NWJ Kelleners-Smeets, K Mosterd, BAB Essers

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Benjamin Hidalgo-Matlock
Skin Care Physicians of Costa Rica

Clinica Victoria en San Pedro: 4000-1054
Momentum Escazu: 2101-9574

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