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首页> 外文期刊>PharmacoEconomics >Cost effectiveness of imiquimod 5% cream compared with methyl aminolevulinate-based photodynamic therapy in the treatment of non-hyperkeratotic, non-hypertrophic actinic (solar) keratoses: a decision tree model.
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Cost effectiveness of imiquimod 5% cream compared with methyl aminolevulinate-based photodynamic therapy in the treatment of non-hyperkeratotic, non-hypertrophic actinic (solar) keratoses: a decision tree model.

机译：与基于氨基乙酰丙酸甲酯的光动力疗法相比，咪喹莫特5％乳膏治疗非角化过度，非肥大性光化性（太阳能）角化病的成本效益：决策树模型。

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BACKGROUND: Actinic keratosis (AK) is caused by chronic exposure to UV radiation (sunlight). First-line treatments are cryosurgery, topical 5-fluorouracil (5-FU) and topical diclofenac. Where these are contraindicated or less appropriate, alternatives are imiquimod and photodynamic therapy (PDT). OBJECTIVE: To compare the cost effectiveness of imiquimod and methyl aminolevulinate-based PDT (MAL-PDT) from the perspective of the UK NHS. METHODS: A decision tree model was populated with data from a literature review and used to estimate costs and QALYs gained and incremental cost effectiveness over 1 year. The model simulated patients who were in secondary care, who had four to nine AK lesions, and for whom cryosurgery, 5-FU and diclofenac were contraindicated or considered less appropriate. RESULTS: Over 1 year, imiquimod cost pound174 less than MAL-PDT (year 2006 values) but resulted in 0.005 fewer QALYs gained. The incremental cost-effectiveness ratio (ICER) of MAL-PDT over imiquimod was pound34,576. In the probabilistic sensitivity analysis, there was a 75% probability that imiquimod was cost effective compared with MAL-PDT at a threshold of pound20,000 per QALY gained, falling to 73% at pound30,000. CONCLUSIONS: Imiquimod may be the more cost-effective treatment at conventional cost-effectiveness thresholds. A direct head-to-head study of MAL-PDT versus imiquimod is required to reduce uncertainty.
机译：背景：光化性角化病（AK）是由长期暴露于紫外线辐射（阳光）引起的。一线治疗是冷冻手术，局部5-氟尿嘧啶（5-FU）和局部双氯芬酸。在禁忌或不太合适的地方，可以使用咪喹莫特和光动力疗法（PDT）。目的：从英国NHS的角度比较以咪喹莫特和氨基乙酰丙酸甲酯为基础的PDT（MAL-PDT）的成本效益。方法：决策树模型填充了来自文献综述的数据，并用于估算成本和在一年内获得的QALY和增量成本效益。该模型模拟了处于二级保健，有4至9个AK病变，禁忌冷冻手术，5-FU和双氯芬酸的患者或认为不太合适的患者。结果：在1年多的时间里，咪喹莫特的成本比MAL-PDT（2006年的价值）低174英镑，但导致获得的QALY减少0.005英镑。相对于咪喹莫特，MAL-PDT的增量成本效益比（ICER）为£34,576。在概率敏感性分析中，与MAL-PDT相比，在每增加一个QALY 20,000英镑的阈值下，咪喹莫特具有成本效益的概率为75％，在30,000英镑的情况下降至73％。结论：在常规成本效益阈值下，咪喹莫特可能是更具成本效益的治疗方法。为了减少不确定性，需要对MAL-PDT与咪喹莫特进行直接面对面的研究。

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