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

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Abstract

Background

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).

Objective

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.

Methods

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.

Results

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 £20,000 per QALY, with a minimal additional cost of £43 and £105, respectively per QALY gained.

Conclusions

Ingenol mebutate gel is a cost-effective therapy for the first-line treatment of AK from a Scottish NHS perspective.

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Acknowledgments

This study was funded by LEO Pharma.

Author information

Authors and Affiliations

  1. Tolley Health Economics, Buxton, Derbyshire, UK

    Keith Tolley

  2. Department of Dermatology, Vale of Leven Hospital, Alexandria, Dunbartonshire, UK

    Danny Kemmett

  3. LEO Pharma, Hurley, Berkshire, UK

    Signe Thybo & Ruth Nasr

  4. Abacus International, Bicester, Oxfordshire, UK

    Helen Smethurst

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Correspondence to Helen Smethurst.

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Tolley, K., Kemmett, D., Thybo, S. et al. A cost-utility analysis of ingenol mebutate gel for the treatment of actinic keratosis: a Scottish perspective. Eur J Health Econ 17, 287–304 (2016). https://doi.org/10.1007/s10198-015-0679-8

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  • DOI: https://doi.org/10.1007/s10198-015-0679-8

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