To the Editor,
Actinic keratoses (AKs) are skin lesions that can progress to squamous cell carcinomas. When multiple AKs occur in one area, field treatment, often topical or photodynamic therapy, may be used.1 While highly effective, topical 5-fluorouracil (5-FU) may be underutilized due to its intense treatment effects and 2-4 week duration.1,2 To improve symptoms and shorten treatment duration, a regimen of 5-FU with topical calcipotriol or calcipotriene has been proposed, and a 2017 randomized trial showed promising efficacy.3 We quantified the use of 5-FU and 5-FU with calcipotriene over time.
We conducted a retrospective cohort study using three de-identified datasets: MarketScan (commercial insurance claims; 2015-2022; 72,200,665 patients), Medicare claims (2015-2021; 4,300,961 beneficiaries), and Epic Cosmos (Epic electronic health record (EHR) data; 2015-2024; 12,970,421,167 encounters; United States only). In MarketScan and Medicare, we included topical 5-FU prescriptions and calculated the percentage with same-day topical calcipotriene prescriptions. In Epic Cosmos, we included encounters with a topical 5-FU prescription or administration and calculated the percentage with a topical calcipotriene prescription or administration. We used Joinpoint regression analysis to evaluate average annual percent changes.
We identified 499,649 5-FU prescriptions in MarketScan, of which 11,201 (2.24%) involved calcipotriene, 276,872 5-FU prescriptions in Medicare, of which 4,032 (1.46%) involved calcipotriene, and 497,692 encounters with 5-FU in Epic Cosmos, of which 15,020 (3.02%) involved calcipotriene. The proportion of prescriptions with 5-FU and calcipotriene increased from 0.09% in 2015 to 3.22% in 2022 in MarketScan; from 0.08% in 2015 to 2.23% in 2020 before decreasing to 2.04% in 2021 in Medicare; and from 0.08% in 2015 to 4.18% in 2021 before decreasing to 3.10% in 2024 in Epic Cosmos (Table 1). Average annual percent changes in proportions of 5-FU prescribed with calcipotriene were 53.62% (95% CI 37.99-87.61) in MarketScan, 64.87% (95% CI 50.39-98.68) in Medicare, and 53.96% (95% CI 39.40-76.84) in Epic Cosmos.
Actinic keratoses (AKs) are skin lesions that can progress to squamous cell carcinomas. When multiple AKs occur in one area, field treatment, often topical or photodynamic therapy, may be used.1 While highly effective, topical 5-fluorouracil (5-FU) may be underutilized due to its intense treatment effects and 2-4 week duration.1,2 To improve symptoms and shorten treatment duration, a regimen of 5-FU with topical calcipotriol or calcipotriene has been proposed, and a 2017 randomized trial showed promising efficacy.3 We quantified the use of 5-FU and 5-FU with calcipotriene over time.
We conducted a retrospective cohort study using three de-identified datasets: MarketScan (commercial insurance claims; 2015-2022; 72,200,665 patients), Medicare claims (2015-2021; 4,300,961 beneficiaries), and Epic Cosmos (Epic electronic health record (EHR) data; 2015-2024; 12,970,421,167 encounters; United States only). In MarketScan and Medicare, we included topical 5-FU prescriptions and calculated the percentage with same-day topical calcipotriene prescriptions. In Epic Cosmos, we included encounters with a topical 5-FU prescription or administration and calculated the percentage with a topical calcipotriene prescription or administration. We used Joinpoint regression analysis to evaluate average annual percent changes.
We identified 499,649 5-FU prescriptions in MarketScan, of which 11,201 (2.24%) involved calcipotriene, 276,872 5-FU prescriptions in Medicare, of which 4,032 (1.46%) involved calcipotriene, and 497,692 encounters with 5-FU in Epic Cosmos, of which 15,020 (3.02%) involved calcipotriene. The proportion of prescriptions with 5-FU and calcipotriene increased from 0.09% in 2015 to 3.22% in 2022 in MarketScan; from 0.08% in 2015 to 2.23% in 2020 before decreasing to 2.04% in 2021 in Medicare; and from 0.08% in 2015 to 4.18% in 2021 before decreasing to 3.10% in 2024 in Epic Cosmos (Table 1). Average annual percent changes in proportions of 5-FU prescribed with calcipotriene were 53.62% (95% CI 37.99-87.61) in MarketScan, 64.87% (95% CI 50.39-98.68) in Medicare, and 53.96% (95% CI 39.40-76.84) in Epic Cosmos.
