Local radiation and phototherapy are the most cost-effective treatments for stage IA mycosis fungoides: A comparative decision analysis model in the United States - 14/01/19
Abstract |
Background |
Treatments for early-stage mycosis fungoides (MF) include topical steroids, topical nitrogen mustard, topical bexarotene, narrowband ultraviolet B (NBUVB), psoralen plus ultraviolet A (PUVA), and local radiation. The relative cost-effectiveness of each treatment given the differences in treatment failure, disease progression, and therapy escalation is not established.
Objective |
To compare the cost-effectiveness (CE) of treatment options for stage IA MF.
Methods |
A state-transition model was constructed with health states of stage IA to stage IV disease, no MF, and death. Treatment-specific remission and relapse rates were obtained from the literature. Lifetime costs were calculated by accounting for medications, office visits, laboratory monitoring, related procedures, work absences, and travel.
Results |
The order of CE of the study treatments was determined to be as follows: local radiation, $225,399 for 15.40 life-years (LYs); NBUVB, $344,728 for 15.17 LYs; PUVA, $371,741 for 15.07 LYs; topical corticosteroids, $469,354 for 14.65 LYs; topical nitrogen mustard, $951,662 for 14.29 LYs; and topical bexarotene, 11,892,496 for 13.55 LYs. Sensitivity analyses confirmed the CE rankings.
Limitations |
We assumed a constant probability of response, relapse rates, and 3-month treatment intervals.
Conclusions |
Local radiation is the most cost-effective treatment for limited local disease, whereas phototherapy (NBUVB or PUVA) is cost-effective for generalized disease. Our findings can serve to inform future studies and recommendations regarding selection of therapy for stage IA MF.
Le texte complet de cet article est disponible en PDF.Key words : cost-effectiveness, mycosis fungoides, stage IA, treatment
Abbreviations used : BSA, CE, FDA, LY, MF, NBUVB, NM, PSA, PUVA
Plan
| Preliminary results were displayed as a poster at the Annual Meeting of the American Academy of Dermatology, San Diego, CA, February 16-20, 2018. |
|
| Funding sources: Supported by the Cochrane Scholarship from the American Academy of Dermatology, the Women's Dermatologic Society, and the Skin Cancer Foundation. |
|
| Conflicts of interest: None disclosed. |
Vol 80 - N° 2
P. 485 - février 2019 Retour au numéro
Article précédent
- Association of skin hyperpigmentation disorders with digital ulcers in systemic sclerosis: Analysis of a cohort of 239 patients
- Vaianu Leroy, Pauline Henrot, Thomas Barnetche, Muriel Cario, Anne-Sophie Darrigade, Pauline Manicki, Marie-Sylvie Doutre, Estibaliz Lazaro, Joel Constans, Damien Barcat, Jean-Philippe Vernhes, Christophe Richez, Alain Taieb, Marie-Elise Truchetet, Julien Seneschal, Fédération Hospitalo-Universitaire–Aquitaine's Care and Research Organisation for Inflammatory and Immune-Mediated Diseases
- Late growth of infantile hemangiomas in children >3 years of age: A retrospective study
- Kathleen F. O'Brien, Sonal D. Shah, Elena Pope, Roderic J. Phillips, Francine Blei, Eulalia Baselga, Maria C. Garzon, Catherine McCuaig, Anita N. Haggstrom, Peter H. Hoeger, James R. Treat, Marissa J. Perman, Jane S. Bellet, Xavier Cubiró, Jeffrey Poole, Ilona J. Frieden
Bienvenue sur EM-consulte, la référence des professionnels de santé.
L’accès au texte intégral de cet article nécessite un abonnement.
Déjà abonné à cette revue ?