Pharmacoeconomic Analysis of the Treatment of Multiple Actinic Keratoses
January 2008 | Volume 7 | Issue 1 | Original Article | 23 | Copyright © January 2008
Michael H. Gold MD
Actinic keratosis (AK) is common and lesions may progress to squamous cell carcinoma. The choice of therapy depends
mainly on 2 factors: the efficacy of therapeutic options and the number of lesions present. Cryotherapy alone is suitable
for treating a few lesions, whereas topical medications, photodynamic therapy (PDT) with 5-aminolevulinic acid (ALA),
or either in combination with cryotherapy are appropriate for treating multiple (>15) lesions. When combinations are
necessary, the total cost to treat multiple AKs to 100% clearance becomes important. This report provides a simple pharmacoeconomic
analysis of 4 FDA-cleared therapies (imiquimod, diclofenac, 5-fluorouacil [5-FU], and ALA PDT) for AK
given in combination with cryotherapy. This analysis assumes standard costs of procedures and office visits (based on April
2007 reimbursement data) and 2 treatment courses (medications: imiquimod, diclofenac, 5-FU) or sessions (ALA PDT)
of each modality followed by cryotherapy to 100% clearance. The total cost of each combination is $725.17 for ALA PDT,
$845.07 for diclofenac, $942.13 for 5-FU, and $1,473.39 for imiquimod. When phase III trial efficacies of the 4 modalities
are considered, the actual cost of using imiquimod or diclofenac increases because additional treatments may be required.
Among these 4 FDA-cleared therapies for multiple AK lesions, ALA PDT is the least expensive treatment and
imiquimod is the most expensive treatment under the stated assumptions.