Cost Effectiveness of Imiquimod 5% Cream Compared with Methyl Aminolevulinate-Based Photodynamic Therapy in the Treatment of Non-Hyperkeratotic, Non-Hypertrophic Actinic (Solar) Keratoses A Decision Tree Model: A Decision Tree Model

• Published in: PharmacoEconomics 2010-11, Vol.28 (11), p.1055-1064
• Main Author: Wilson, Edward C. F.
• Format: Article
• Language: English
• Subjects: Actinic keratosis; Aminolevulinic Acid - adverse effects; Aminolevulinic Acid - analogs & derivatives; Aminolevulinic Acid - economics; Aminolevulinic Acid - therapeutic use; Aminoquinolines - administration & dosage; Aminoquinolines - adverse effects; Aminoquinolines - economics; Aminoquinolines - therapeutic use; Antineoplastic Agents - administration & dosage; Antineoplastic Agents - adverse effects; Antineoplastic Agents - economics; Antineoplastic Agents - therapeutic use; Biological and medical sciences; Cancer; Care and treatment; Chronic illnesses; Clinical trials; Cost analysis; Cost benefit analysis; Cost estimates; Cost-utility; Data Interpretation, Statistical; Decision Trees; Dermatology; Dosage and administration; Dyskeratosis; Economic aspects; Health Administration; Health aspects; Health Economics; Humans; Imiquimod; Injuries of the skin. Diseases of the skin due to physical agents; Keratosis; Keratosis, Actinic - drug therapy; Keratosis, Actinic - economics; Literature reviews; Medical sciences; Medicine; Medicine & Public Health; Methods; Methyl-aminolevulinate; Models, Economic; Nonsteroidal anti-inflammatory drugs; Original Research Article; Patient outcomes; Patients; Pharmacoeconomics and Health Outcomes; Pharmacology. Drug treatments; Photochemotherapy; Photochemotherapy - adverse effects; Photochemotherapy - economics; Photodynamic therapy; Photosensitizing Agents - adverse effects; Photosensitizing Agents - economics; Photosensitizing Agents - therapeutic use; Public Health; Quality of Life Research; Quality-Adjusted Life Years; Sensitivity analysis; Skin, nail, hair, dermoskeleton; Source studies; Studies; therapeutic use; Traumas. Diseases due to physical agents; treatment; Ultraviolet radiation; United Kingdom
• ISSN: 1170-7690; 1179-2027
• DOI: 10.2165/11538670-000000000-00000

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 d34 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 MALPDT versus imiquimod is required to reduce uncertainty.