Abstract
Background: Currently available topical treatments for actinic keratosis (AK) adversely affect patients’ quality of life because of long treatment durations and long-lasting local skin reactions (LSRs), which may result in poor treatment adherence and patient outcomes. Ingenol mebutate gel, a recently introduced treatment for AK, is administered for 2 or 3 days, and LSR’s are predicable in onset and duration.Objectives: The objective of the study was to estimate the value of ingenol mebutate gel’s shorter treatment duration and tolerability profile to potential patients, versus existing topical treatments (imiquimod 3.75%, imiquimod 5% and diclofenac 3%) in the United States.Methods: The open-ended Contingent Valuation (CV) approach was used to estimate incremental willingness-to-pay (WTP) for ingenol mebutate gel rather than treatment with imiquimod 5%, imiquimod 3.75% and diclofenac 3%. Profiles for each therapy differed in regards to treatment duration, time-to-LSR resolution, and price. Subjects were asked to state their maximum out-of-pocket WTP to receive ingenol mebutate gel instead of each of the three alternatives.Results: 103 subjects provided usable answers. Between 48% and 63% of subjects were willing to pay extra to gain access to treatment with the ingenol mebutate gel profile instead of the comparators, and the mean incremental WTP ranged from $475 to $518. Subjects with experience of topical treatment stated higher WTP for accessing ingenol mebutate gel. Subjects whose most bothersome AK area was the full scalp or forehead also claimed higher WTP for ingenol mebutate gel.Conclusions: Patients diagnosed with AK indicated an unmet need for fast-acting topical treatment with shorter LSR resolution time.
Highlights
Available topical treatments for actinic keratosis (AK) adversely affect patients’ quality of life because of long treatment durations and long-lasting local skin reactions (LSRs), which may result in poor treatment adherence and patient outcomes
Patients diagnosed with AK indicated an unmet need for fast-acting topical treatment with shorter LSR resolution time
Actinic keratosis (AK), a precursor to non-melanoma skin cancer, is a skin condition consisting of thick, scaly, or crusty patches of lesions, often located in areas chronically exposed to the sun of fair-skinned, middle-aged and older individuals.[1]
Summary
Available topical treatments for actinic keratosis (AK) adversely affect patients’ quality of life because of long treatment durations and long-lasting local skin reactions (LSRs), which may result in poor treatment adherence and patient outcomes. Actinic keratosis (AK), a precursor to non-melanoma skin cancer, is a skin condition consisting of thick, scaly, or crusty patches of lesions, often located in areas chronically exposed to the sun (such as the face, scalp, and hands) of fair-skinned, middle-aged and older individuals.[1] Studies suggest that 60-65% of squamous cell carcinoma (SCC) begin as AK2,3 and, while the majority of AK lesions remain stable or even regress,[4] studies suggest that 0.6% of AK lesions progress to squamous cell carcinoma (SCC) each year[3] and up to 10% progress over a 10-year period.[5] Anxiety related to the risk of skin cancer may, reduce health-related quality of life (HRQoL), as may a general unwillingness to interact socially because of the unsightly appearance ( when presenting on the face or scalp).[6]. Known risk factors for AK include chronic exposure to the sun (especially sunburn damage), fair skin and blue or light-colored eyes, blond or red hair, advancing age, and immunosuppression.[7,8,9] In the United States and Europe, these risk factors are common; estimates of the prevalence of AK range from 11% to 26% of the general population.[10,11] The economic burden is substantial; for example, the annual direct costs related to treating AK and the indirect costs of foregone work productivity in the United States were estimated at $1.2 billion and $295 million, respectively, in 2004.12
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