One of the best ways to prevent skin cancer from developing in the first place is to eliminate precancerous skin conditions—those that have a propensity for developing into actual cancer. In recent years, the light-based approach known as photodynamic therapy (PDT) has proved to be very effective for attacking both the health problems mentioned above, and there is some evidence that PDT also may be more cost-effective than some of its more mainstream counterparts.
This article will focus on a common, irritating skin condition known as actinic keratosis, or AK. This problem is seen most often in fair-skinned people after years of frequent sun exposure. The condition can progress and transform into non-melanoma skin cancer, notably squamous cell carcinoma.
Dermatology researchers at the University of Brescia in Italy, recently conducted a randomized controlled clinical trial to address the possibility that PDT could be both medically and financially effective as a treatment for AK. They evaluated two methods of treating AK: (1) a gel containing Diclofenac and hyaluronic acid (DHA) and (2) photodynamic therapy with methyl aminolevulinate (MAL-PDT). The goal was to compare the treatment results and cost effectiveness of these two popular treatment methods.
Patients with at least five AKs on the face and scalp were randomly assigned to receive MAL-PDT or DHA. After three months, the remission rates were assessed, and an investigator scored the cosmetic outcome as well. In addition, all AK patients were asked to rate their overall satisfaction with the treatment, and patients with complete remissions of all lesions were then observed for a full year.
It was clear from this study that MAL-PDT was a more effective treatment: The complete remission rates at three months were 86% with MAL-PDT and 52% with DHA. Notably, the researchers observed that AKs of all thickness grades were significantly more responsive to MAL-PDT.
At the one-year examination point, the number of complete remissions was 37 with MAL-PDT and 7 with DHA. Cosmetic outcomes were rated to be very good or excellent for the vast majority of patients, regardless of the treatment. However, the cosmetic outcome and patients’ overall satisfaction regarding MAL-PDT were superior to that of DHA.
The analysis of cost effectiveness showed that the costs per complete remission at three months and at 12 months were 566.7 € and 1026.2 €, respectively, with MAL-PDT, compared to 595.2 € and 2295.6 €, respectively with DHA. Thus, although MAL-PDT was more expensive, it ultimately proved to be more cost-effective, as reported in the 7 February 2014 British Journal of Dermatology.
The same Italian research team also reported that cryotherapy is preferable to carbon dioxide laser therapy for the treatment of isolated AKs of the face and scalp. Studies are now in progress to determine whether combinations of PDT with cryotherapy may lead to superior treatment outcomes for both precancerous and cancerous skin conditions.
Recently a pan-European group of dermatologists with expertise met to discuss current best practices in PDT for the treatment of AK in organ transplant recipients (a high risk group), as reported in the Journal of the European Academy of Dermatology and Venereology. They concluded that a large randomized controlled trial is needed “to provide robust data on safety, efficacy and optimal pain control, and to provide pharmaco-economics data that can be used to support extended reimbursement in this patient group.”
Medical policymakers in many countries are constantly looking for ways to cut costs. If such cost-cutting efforts can be successful at the level of cancer prevention, so much the better. This certainly seems to be the case with the use of MAL-PDT for precancerous skin conditions, though more research.
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Zane C1, Facchinetti E, Rossi M, Specchia C, Calzavara-Pinton P. A randomized clinical trial of photodynamic therapy with methylaminolevulinate versus 3% diclofenac plus hyaluronic acid gel for the treatment of multiple actinic keratoses of the face and scalp. Br J Dermatol. 2014 Feb 7. [Epub ahead of print]
Zane C1, Facchinetti E, Rossi MT, Specchia C, Ortel B, Calzavara-Pinton P. Cryotherapy is preferable to ablative CO2 laser for the treatment of isolated actinic keratoses of the face and scalp: a randomised clinical trial. Br J Dermatol. 2014 Jan 28. [Epub ahead of print]
Basset-Seguin N1, Baumann Conzett K, Gerritsen MJ, Gonzalez H, Haedersdal M, Hofbauer GF, Aguado L, Kerob D, Lear JT, Piaserico S, Ulrich C. Photodynamic therapy for actinic keratosis in organ transplant patients. J Eur Acad Dermatol Venereol. 2013 Jan;27(1):57-66.
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