Method: A cost-effectiveness analysis was conducted to determine which therapy for field change on the head area is the most cost-effective at 12-months post-treatment when comparing 5% 5-fluorouracil cream, 5% imiquimod cream, 0.015% ingenol mebutate gel and methyl aminolevulinate photodynamic therapy. A decision tree was modelled from the patient perspective, using TreeAge Pro. Efficacy data was derived from a single-blinded, multi-centre, prospective randomised control trial. Cost data was derived from Australian dermatology clinics and pharmacies. One-way and probabilistic sensitivity analyses were conducted to evaluate the robustness of the results.
Results: 5-fluorouracil was the most cost-effective treatment, with a cost-effectiveness ratio of $186.32. When varying 5-FU in its lower bound efficacy values and higher bound cost values, 5-fluorouracil continued to dominate all other treatments. Probabilistic sensitivity analyses showed almost complete certainty (99.98%) in 5-fluorouracils dominance over the other three treatments.
Discussion: The results of the base-case cost-effectiveness analysis showed that 5-FU cream was the most cost-effective field therapy for AKs at 12-months post-treatment. Despite this being a trial-based cost-effectiveness analysis, all economic evaluations are limited by the uncertainty of their input parameters. In this analysis, only four commonly used field therapies were compared, with alternative treatments like diclofenac and retinoids being excluded. Finally, cost-effectiveness analyses exclude auxiliary considerations relevant to clinical practice, including pain, downtimes, cosmesis and access to dermatology services.
Implications for practice: From an economic perspective, general practitioners should consider topical 5-fluoruracil as the first-line field therapy for actinic damage.