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Giornale Italiano di Dermatologia e Venereologia 2010 October;145(5):573-81

Copyright © 2010 EDIZIONI MINERVA MEDICA

language: English

Cost-effectiveness analysis of topical treatments for actinic keratosis in the perspective of the Italian health care system

Colombo G. L. ^{1, 2}, Chimenti S. ³, Di Matteo S. ², Fargnoli M. C. ⁴, Frascione P. ⁵, Silipo V. ⁵, Peris K. ⁴ ✉

¹ University of Pavia, Faculty of Pharmacy, Pavia, Italy; ² S.A.V.E. Studi Analisi Valutazioni Economiche, Milan, Italy; ³ Department of Dermatology, University of Rome Tor Vergata, Rome, Italy; ⁴ Department of Dermatology, University of l’Aquila, L’Aquila Italy; ⁵ Dermatological Institute San Gallicano, Rome, Italy

Actinic keratosis (AK) is the most common cutaneous malignant neoplasm and its prevalence continues to increase. According to the most recent findings, AK is currently considered the initial stage, in situ, of squamous cell carcinoma. Field-directed therapies for AKs are the preferred treatment since they have the advantage to clear the clinically visible lesions and also subclinical lesions within the cancerous field. We assessed the cost-effectiveness of topical treatments for AKs including 3% diclofenac in 2.5% hyaluronic acid (HA) gel, imiquimod 5% cream and photodynamic therapy with methyl aminolevulinate (MAL-PDT) in the perspective of the Italian Health Care System (SSN). We used a decision tree analytical approach and efficacy data were drawn from published clinical trials. Cost was evaluated from the SSN perspective during a time horizon of 3 months. A responder was defined as a patient with all lesions clinically cleared and showing an excellent cosmetic result. Based on the applied model, the cost per complete responder was calculated. Diclofenac 3% in HA was less expensive (€ 256) than MAL-PDT (€ 320) and imiquimod (€ 342). Effectiveness was similar and better for diclofenac 3% in HA and MAL-PDT (0.813%) in comparison to 0.734% of imiquimod, respectively. The one-way and probabilistic sensitivity analyses confirmed the results of base case scenario. Based on this cost-effectiveness model, diclofenac 3% in HA can be considered the treatment of choice for AK lesions and surrounding field under a pharmacoeconomic point of view.