Caekelbergh et al

Title: Economic evaluation of methyl aminolaevulinate-based photodynamic therapy in the management of actinic keratosis and basal cell carcinoma.

Author: Caekelbergh K, Annemans L, Lambert J, Roelandts R.

Journal Reference: Br J Dermatol 2006;155 (4):784-90. (by clicking on this link you will be leaving this site - Galderma is not responsible for the content)

Objective: to evaluate the cost-effectiveness of photodynamic therapy with methyl aminolaevulinate cream (MAL; Metvix®) in the treatment of actinic keratosis and basal cell carcinomas (both superficial and nodal).

Design: this Belgian study calculated the cost of treatment with photodynamic therapy and methyl aminolaevulinate cream for a full responder: defined as a patient with clinically responding lesions and an excellent cosmetic. This corresponded to the cost-effectiveness ratio.

A medical decision tree simulated the possible outcomes after treatment with either photodynamic therapy or an alternative treatment modality, cryotherapy for actinic keratosis and excision surgery for basal cell carcinoma.  Clinical data for the model came from published studies and information on medical management from a Delphi panel of dermatologists. The analytical perspective was that of the Belgian public health system and only direct medical costs were considered.

Treatment outcomes were simulated over one year for actinic keratosis and five years for basal cell carcinoma to allow time for possible recurrence.

Key Results:

  • The cost of photodynamic therapy per full responder is comparable with cryotherapy in actinic keratosis (€379.20 and €363.20  respectively)
  • The cost of photodynamic therapy per full responder in nodular basal cell carcinoma and superficial basal cell carcinoma is considerably less than excision surgery
  • €1209.70 for photodynamic therapy compared with €3803.00 for excision surgery in superficial basal cell carcinoma.
  • €1022.00 for photodynamic therapy compared with €3797.80 for excision surgery in nodular basal cell carcinoma

Conclusion: in basal cell carcinoma, photodynamic therapy with methyl aminolaevulinate cream (MAL; Metvix®) provides better value for money than conventional treatment by excision surgery. If society is willing to pay 1.50€ per day of response, methyl aminolaevulinate cream (MAL; Metvix®), is a cost-effective intervention in AK taking a 1-year time horizon