Economic evaluation of methyl aminolaevulinate-based photodynamic therapy in the management of actinic keratosis and basal cell carcinoma

K. Caekelbergh, L. Annemans, J. Lambert and R. Roelandts

HEDM (Health Economics and Disease Management), Brussels, Belgium
Faculty of Medicine, University of Ghent, Ghent, Belgium
Department of Dermatology, University Hospital Antwerp, Antwerp, Belgium
Photodermatology Unit, University Hospital Leuven, Leuven, Belgium

Background Various effective therapeutic options are currently available for the treatment of actinic keratosis (AK) and basal cell carcinoma (BCC), but none is perfect. Poor cosmesis resulting from surgical procedures and skin irritation induced by topical agents remain significant problems. Objectives To evaluate the cost-effectiveness of a recent approach, methyl aminolaevulinate based photodynamic therapy (MAL-PDT; Metvix; Galderma, Lausanne, Switzerland) in AK and BCC.

Methods A medical decision tree was developed for simulation of all possible outcomes associated with the medical decision to apply MAL-PDT or a comparator.

The time horizon was 1 year for AK and 5 years for BCC. The comparators were cryotherapy in AK and excision surgery in BCC. Clinical data for the model were obtained from the literature. Data on medical management resulted from a Delphi panel performed among 12 Belgian dermatologists. Based on the model, the cost per full responder was calculated, whereby a responder was defined as a patient with all lesions clinically responding and showing an excellent cosmetic result.

Results MAL-PDT is a more expensive treatment compared with cryotherapy for AK. However, the cost per full responder is comparable with cryotherapy (€363 and €379, respectively). Incremental cost per extra full responder is €401. Incremental cost per full responder is €469 for nodular BCC and €251 for superficial BCC, both compared with excision surgery.

Conclusions
The results suggest that MAL-PDT is a cost-effective intervention in AK taking a 1-year time horizon, if society is willing to pay €1Æ50 per day of response, and that MAL-PDT is better value for money than excision in BCC, taking a 5-year time horizon.

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