A cost-utility analysis of ingenol mebutate gel for the treatment of actinic keratosis: a Scottish perspective

被引:11
作者
Tolley, Keith [1 ]
Kemmett, Danny [2 ]
Thybo, Signe [3 ]
Nasr, Ruth [3 ]
Smethurst, Helen [4 ]
机构
[1] Tolley Hlth Econ, Buxton, Derby, England
[2] Vale Leven Hosp, Dept Dermatol, Alexandria, Dunbarton, England
[3] LEO Pharma, Hurley, Berks, England
[4] Abacus Int, Bicester, Oxon, England
关键词
Ingenol mebutate gel; Actinic keratosis; Cost-effectiveness; ICER; PHOTODYNAMIC THERAPY; 5-AMINOLEVULINIC ACID; SOLAR KERATOSES; SKIN-CANCER; 5-FLUOROURACIL; CREAM; CHEMOPREVENTION; UNCERTAINTY;
D O I
10.1007/s10198-015-0679-8
中图分类号
F [经济];
学科分类号
02 ;
摘要
Actinic keratosis (AK) is a UV-induced, pre-malignant skin condition that is common in adults over 60 years of age with fair skin in Scotland. The most commonly prescribed first-line treatment for AK in Scotland is currently diclofenac gel (3 %). Ingenol mebutate gel is a recently developed topical therapy available in two strengths for the treatment of AK lesions on the face and scalp (150 mcg/g once daily for 3 consecutive days) or trunk and extremities (500 mcg/g once daily for 2 consecutive days). To compare the cost-effectiveness of two strengths of ingenol mebutate gel developed to treat AK lesions on the face and scalp (150 mcg/g once daily for 3 consecutive days) or trunk and extremities (500 mcg/g once daily for 2 consecutive days) with other first-line AK therapies including diclofenac gel, 5-FU, 5-FU/salicylic acid, and cryotherapy for the first-line treatment of AK in adult patients, from the perspective of the National Health Service (NHS) in Scotland. A cost-utility analysis was conducted using a decision-tree approach to calculate the costs and benefits of different treatment strategies for AK on the face and scalp or trunk and limbs over a 12-month time horizon. Data on the relative efficacy of treatments were obtained from a systematic literature review and meta-analysis. Utility scores and resource-use data were obtained from published sources. Over 12 months, ingenol mebutate 150 mcg/g gel and 500 mcg/g gel were cost-effective compared with the most commonly used topical therapy in Scotland, diclofenac (3 %) gel, at a willingness-to-pay threshold of A 20,000 pound per QALY, with a minimal additional cost of A 43 pound and A 105 pound, respectively per QALY gained. Ingenol mebutate gel is a cost-effective therapy for the first-line treatment of AK from a Scottish NHS perspective.
引用
收藏
页码:287 / 304
页数:18
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