The European Journal of Health Economics

, Volume 17, Issue 3, pp 287–304 | Cite as

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

  • Keith Tolley
  • Danny Kemmett
  • Signe Thybo
  • Ruth Nasr
  • Helen Smethurst
Original Paper



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).


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.


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.


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.


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


Ingenol mebutate gel Actinic keratosis Cost-effectiveness ICER 



This study was funded by LEO Pharma.

Supplementary material

10198_2015_679_MOESM1_ESM.docx (60 kb)
Supplementary material 1 (DOCX 59 kb)
10198_2015_679_MOESM2_ESM.docx (49 kb)
Supplementary material 2 (DOCX 49 kb)


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Copyright information

© Springer-Verlag Berlin Heidelberg 2015

Authors and Affiliations

  • Keith Tolley
    • 1
  • Danny Kemmett
    • 2
  • Signe Thybo
    • 3
  • Ruth Nasr
    • 3
  • Helen Smethurst
    • 4
  1. 1.Tolley Health EconomicsBuxtonUK
  2. 2.Department of DermatologyVale of Leven HospitalAlexandriaUK
  3. 3.LEO PharmaHurleyUK
  4. 4.Abacus InternationalBicesterUK

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