Real-life Data on Patient Characteristics, Cost and Effectiveness of Field-directed Treatment for Actinic Keratoses: An Observational Study

Abstract

Actinic keratoses (AK) occur frequently; however, real-life clinical data on personalized treatment choice and costs are scarce. This multicentre one-year observational study investigated patient-characteristics, cost and effectiveness of methylaminolaevulinate photodynamic therapy (MAL-PDT), imiquimod (IMI) and 5-fluorour-acil (5-FU) in patients with AKs on the face/scalp. A total of 104 patients preferred MAL-PDT, 106 preferred IMI and 110 preferred 5-FU. At baseline, significant differences between treatment groups were found; most patients were severely affected (mean 32.5 AK in PDT-group, 20.2 in IMI-group, 22.8 in 5-FU-group). A mean reduction in lesions of 81% after MAL-PDT, 82% after IMI and 88% after 5-FU was found after one year. Annual costs were €1,950 for MAL-PDT, €877 for IMI and €738 for 5-FU. These results show that, compared with clinical trials, in the real-life clinical setting AK patients are usually more severely affected and treatment costs are much higher. Furthermore, patient characteristics are important factors in treatment choice.

A trial‐based cost‐effectiveness analysis of topical 5‐fluorouracil vs. imiquimod vs. ingenol mebutate vs. methyl aminolaevulinate conventional photodynamic therapy for the treatment of actinic keratosis in the head and neck area performed in the Netherlands

“…In a real-life cohort study by van Rijsingen et al, treatments with 5-FU, IMQ and MAL-PDT were compared. 17 They found that treatment with 5-FU 5% had the lowest annual costs (€738), compared with IMQ (€877) and MAL-PDT (€1950), and resulted in the largest reduction of lesions. 17 Our total annual costs for treatment with 5-FU (€433), IMQ (€728) and MAL-PDT (€1621) were lower, which might be explained by the fact that their patients were more severely affected than ours.…”

“…In a real‐life cohort study by van Rijsingen et al ., treatments with 5‐FU, IMQ and MAL‐PDT were compared . They found that treatment with 5‐FU 5% had the lowest annual costs (€738), compared with IMQ (€877) and MAL‐PDT (€1950), and resulted in the largest reduction of lesions .…”

“…Although cost-effectiveness modelling studies have been performed in which different treatments for AK were compared, a prospective clinical trial comparing four frequently prescribed treatments on effectiveness and real resource consumption with a time horizon of 12 months has never been conducted. [12][13][14][15][16][17] Recently, we showed, that 5-fluorouracil (5-FU) 5% is the most effective field-directed treatment for the management of AK in the head and neck area, compared with imiquimod (IMQ) 5%, ingenol mebutate (IM) 0Á015% and methyl aminolaevulinate photodynamic therapy (MAL-PDT). 18 In this study we evaluated the differences in costs between these four topical treatment modalities for AK in the head and neck area to define the most cost-effective treatment.…”

“…Considering the impact on healthcare costs, it is important to know which treatment is the most cost‐effective. Although cost‐effectiveness modelling studies have been performed in which different treatments for AK were compared, a prospective clinical trial comparing four frequently prescribed treatments on effectiveness and real resource consumption with a time horizon of 12 months has never been conducted …”