Pharmacoeconomic Considerations in Treating Actinic Keratosis: An Update

Abstract

Actinic keratosis is one of the most common dermatological diagnoses worldwide, especially among the elderly, fair-skinned, and immunocompromised, and is associated with a risk of transformation to skin cancer. With actinic keratosis and skin cancer prevalence increasing as the aged population expands in the US, optimizing treatment strategies may produce cost savings for the healthcare system. Since the time of our last review in 2008, investigation of the economic considerations in treating actinic keratosis has advanced. To provide an update of treatment cost effectiveness and to review factors relating to the costs of care, we conducted a systematic review of pharmacoeconomic publications since December 2008. We identified 11 pharmacoeconomic studies, with one cost-of-treatment, five cost-effectiveness, and five cost-utility analyses. Photodynamic therapy (PDT) was well tolerated and produced a favorable cosmetic outcome in most studies. Ingenol mebutate, the newest but most expensive topical field therapy, 5-fluorouracil, and PDT were the most cost-effective treatments in our review. Patient adherence to therapy and the management of adverse effects were significant contributors to treatment costs. In the US, treatment guidelines and formalized cost-effectiveness analyses for actinic keratosis are absent from the recent literature. Future pharmacoeconomic investigation will depend on up-to-date comparative efficacy data, as well as clarification of rates of, and management strategies for, adverse effects, therapeutic non-adherence, and lesion recurrence.

In vivo Confocal Laser Microscopy for monitoring of actinic keratosis treatment: a comparison with histopathologic assessment after treatment with topical 5% 5‐fluorouracil

“…Pharmacoeconomics studies have described 5‐FU as an inexpensive, cost‐effective AK treatment, with great success rates . Immunosuppressed and organ transplanted patients have AKs that are refractory to treatment and progress more rapidly to invasive squamous cell carcinoma .…”

“…59 Pharmacoeconomics studies have described 5-FU as an inexpensive, cost-effective AK treatment, with great success rates. [60][61][62] Immunosuppressed and organ transplanted patients have AKs that are refractory to treatment and progress more rapidly to invasive squamous cell carcinoma. 63 Although this study did not consider immunosuppressed individuals, patients included had intense actinic damage, 86% fair skin, 82% personal history of multiple AK and 70% personal history of non-melanomas cutaneous tumours, which could justify the 32.5% prevalence of lesions treated incompletely by 5-FU.…”

Epithelial‐to‐mesenchymal transition contributes to invasion in squamous cell carcinomas originated from actinic keratosis through the differentiated pathway, whereas proliferation plays a more significant role in the classical pathway

“…The most common precursor of iSCC is actinic keratosis (AK), a highly prevalent lesion in adulthood: approximately 30% of the dermatology outpatient population in Spain aged ≥45 years old have AKs . As life expectancy increases, the incidence of AK is continuing to rise . AK may remain stable for long periods of time, undergo temporary or permanent regression, or evolve into iSCC .…”

Non‐invasive monitoring of subclinical and clinical actinic keratosis of face and scalp under topical treatment with ingenol mebutate gel 150 mcg/g by means of reflectance confocal microscopy and optical coherence tomography: New perspectives and comparison of diagnostic techniques

“…Numerous studies have reported the efficacy of the topically applied gel in the field therapy of AKs and its effect on the clearance of both clinically evident and subclinical lesions [10,12,31,35]. In a long-term follow-up study, Garbe et al [36] reported a persisting clinical clearance in 50% of the patients after 12 months.…”

“…It was originally hypothesized that type III AKs had the main risk of progression, but in 2015, Fernandez‐Figueras et al showed that AKs type 1 actually are the most common lesions associated with invasive SCC; AKs type 2 and AKs type 3 can also progress to SCC albeit with a lower frequency. For this reason, treatment of all AK‐types is generally recommended, and numerous reviews have described the benefits of early therapeutical interventions .…”