Cost-utility of first-line actinic keratosis treatments in Finland.
Adv Ther
; 32(5): 455-76, 2015 May.
Article
em En
| MEDLINE
| ID: mdl-26006101
ABSTRACT
INTRODUCTION:
Cost-utility assessment of first-line actinic keratosis (AK) treatments for max 25 cm2 AK field.METHODS:
A probabilistic, 2-year decision tree model was used to assess costs, quality-adjusted life-years (QALY), incremental cost-effectiveness ratio (ICER), cost-effectiveness efficiency frontier, cost-effectiveness acceptability frontier (CEAF), and expected value of perfect information (EVPI) of AK treatments from the Finnish health care payer perspective with 3% discounting per annum. In the model, the first-line AK treatment resulted in complete clearance (CC) or non-CC with or without local skin responses (LSR), or AK recurrence. Non-CC AK was treated with methyl aminolevulinate+photodynamic therapy (MAL+PDT), and AK recurrence was retreated with the previous effective treatment. Costs included primary and secondary health care, outpatient drugs, and LSR management. QALYs were assessed with the EuroQol (EQ-5D-3L). Result robustness was assessed with sensitivity analyses.RESULTS:
The mean simulated per patient QALYs (costs) were 1.526 (982) for MAL+PDT, 1.524 (794) for ingenol mebutate gel (IngMeb) 0.015% (3 days), 1.522 (869) for IngMeb 0.05% (2 days), 1.520 (1062) for diclofenac 3% (12 weeks), 1.518 (885) for imiquimod 3.75% (6 weeks), 1.517 (781) for imiquimod 5% (4/8 weeks), and 1.514 (1114) for cryosurgery when treating AK affecting any body part. IngMeb 0.015% was less costly and more effective (dominating) than other AK treatments indicated for face and scalp area with the exception of imiquimod 5% for which the ICER was estimated at 1933/QALY gained and MAL+PDT, which had an ICER of 82,607/QALY gained against IngMeb 0.015%. With willingness-to-pay 2526-18,809/QALY gained, IngMeb 0.015% had >50% probability for cost-effectiveness on the CEAF. IngMeb 0.05% dominated AK treatments indicated for trunk and extremities. EVPIs for face and scalp (trunk and extremities) analyses were 26 (0), 86 (58), and 250 (169) per patient with the willingness-to-pay of 0, 15,000, and 30,000 per QALY gained, respectively.CONCLUSION:
IngMebs were cost-effective AK treatments in Finland.FUNDING:
LEO Pharma.
Texto completo:
1
Coleções:
01-internacional
Base de dados:
MEDLINE
Assunto principal:
Custos de Cuidados de Saúde
/
Fármacos Dermatológicos
/
Ceratose Actínica
Tipo de estudo:
Health_economic_evaluation
/
Prognostic_studies
Aspecto:
Patient_preference
Limite:
Humans
País/Região como assunto:
Europa
Idioma:
En
Revista:
Adv Ther
Assunto da revista:
TERAPEUTICA
Ano de publicação:
2015
Tipo de documento:
Article