Prospective follow-up after curettage-cryosurgery for scalp and face skin cancers.

BACKGROUND: Cryosurgery (CS) in the treatment of nonmelanoma skin cancers (NMSCs), especially in the face and on the scalp, has several advantages vs. other methods. Prospectively gathered long-term results after CS are, however, scarce. OBJECTIVES: To establish long-term results after curettage and CS (CCS) of NMSCs in the face and on the scalp considering complication rate, patient tolerance, cosmetic outcome and rate of recurrence. METHODS: Seven hundred and twenty-six patients with 962 face and scalp NMSCs were prospectively followed after CCS (1 week, 3 months, and then annually) during the time period December 1994-September 2008. RESULTS: Mean/median follow-up time was 42/34 months (range 1 month-14 years). Forty-two of 962 (4.4%) received antibiotics due to clinical, superficial infections. No serious complications were recorded. Ninety-nine per cent of the women and 100% of the men graded the cosmetic outcome as 'good' on a three-level scale, follow-up rate 99%. Fifty-six (14%) women and 78 (23%) men (P = 0.001) developed one or more new NMSCs during the study period. Fourteen of 962 (1.5%) recurrences were recorded, in nine women and five men. An expected recurrence-free rate/cure rate of > 97% after 14 years was calculated (Kaplan-Meier). CONCLUSIONS: CCS in the treatment of NMSCs is expedient and well tolerated, with no major and few minor complications. When performed as in the present study it produces good cosmetic results in virtually all cases, with an anticipated 97% cure rate after 14 years. CCS is thus a highly viable alternative in the treatment of NMSCs in the face and on the scalp.

Cost-effectiveness of tacrolimus ointment vs. standard treatment in patients with moderate and severe atopic dermatitis: a health-economic model simulation based on a patient survey and clinical trial data.

BACKGROUND: Atopic dermatitis (AD) affects health and quality of life (QoL) and also has great impact on both healthcare costs and costs to society. OBJECTIVES: The aim of the study was to analyse the cost-effectiveness of treatment with tacrolimus ointment vs. standard treatment in patients with moderate to severe AD. METHODS: A Markov simulation model was constructed capturing several key features of AD and its treatment: disease severity, treatment alternatives, and QoL. The model was populated with data from three sources: (i) efficacy data from a randomized controlled trial including patients with moderate to severe AD treated with either tacrolimus ointment or standard treatment (corticosteroids), (ii) resource utilization and QoL data from a patient survey including 161 Swedish patients with AD, and (iii) official price lists. Costs were calculated according to disease severity for the two treatment alternatives using the perspective of the Swedish healthcare sector. Two analyses were performed, one based on the quantity of medication used in the trial and one based on the survey data. The relationship between effectiveness of tacrolimus ointment and the amount of medication used was tested in sensitivity analyses. RESULTS: In the model simulations patients with severe AD treated with tacrolimus ointment experienced on average 4.6 more AD-free weeks per year than patients given standard treatment. The corresponding figure for patients with moderate AD was 6.5 more AD-free weeks per year. The cost-effectiveness ratios [cost per Quality Adjusted Life Year (QALY) gained] for treatment with tacrolimus ointment vs. standard treatment were 2,334 British pound for moderate AD and 3,875 British pound for severe AD when treatment patterns from the survey were assumed, and 8,269 British pound for moderate AD and 12,304 British pound for severe AD when treatment patterns from the clinical trial were assumed. The results of sensitivity analyses were all well within limits to be considered cost-effective. CONCLUSIONS: Estimates of the incremental cost-effectiveness ratio are far below the currently discussed threshold in Sweden, corresponding to approximately 48,700 British pound per QALY gained, and equivalent thresholds in other countries. Treatment with tacrolimus ointment in patients with moderate and severe AD can therefore be considered cost-effective.