Cost–Utility of First-Line Actinic Keratosis Treatments in Finland

Erkki J. Soini, Taru Hallinen, Anna-Leena Sokka, Kari Saarinen

Cost-utility assessment of first-line actinic keratosis (AK) treatments for max 25 cm(2) AK field. 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. The mean simulated per patient QALYs (costs) were 1.526 (<euro>982) for MAL + PDT, 1.524 (<euro>794) for ingenol mebutate gel (IngMeb) 0.015% (3 days), 1.522 (<euro>869) for IngMeb 0.05% (2 days), 1.520 (<euro>1062) for diclofenac 3% (12 weeks), 1.518 (<euro>885) for imiquimod 3.75% (6 weeks), 1.517 (<euro>781) for imiquimod 5% (4/8 weeks), and 1.514 (<euro>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 <euro>1933/QALY gained and MAL + PDT, which had an ICER of <euro>82,607/QALY gained against IngMeb 0.015%. With willingness-to-pay <euro>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 <euro>26 (<euro>0), <euro>86 (<euro>58), and <euro>250 (<euro>169) per patient with the willingness-to-pay of <euro>0, <euro>15,000, and <euro>30,000 per QALY gained, respectively. IngMebs were cost-effective AK treatments in Finland. LEO Pharma.