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Imiquimod for the Treatment of Actinic Keratosis: A Review of Clinical and Cost-Effectiveness

Last updated: September 15, 2017
Project Number: RC0929-000
Product Line: Rapid Response
Research Type: Drug
Report Type: Summary with Critical Appraisal
Result type: Report

Question

  1. What is the clinical effectiveness of imiquimod for the treatment of actinic keratosis?
  2. What is the cost-effectiveness of imiquimod for the treatment of actinic keratosis?

Key Message

The three included systematic reviews showed that in patients with actinic keratosis (AK), treatment with imiquimod (IMQ) appeared to be better than placebo with respect to complete clearance.Few primary studies were available for comparisons of IMQ with other active treatments for AK, hence definitive conclusions are difficult. There were some inconsistencies in the findings of two network meta-analyses, which presented ranking of the treatments in terms of clinical efficacy, assessed as complete clearance. In one network meta-analyses, starting with the most efficacious treatment, the sequence was flurouracil (FU), aminolevulinic acid photodynamic therapy (ALA-PDT), imiquimod (IMQ), ingenol mebutate (IMB), methylaminolevulinate photodynamic therapy (MAL-PDT), cryotherapy (CTx), diclofenac (DCF) and placebo. In the second network meta-analysis, the sequence was BF-200 ALA-PDT, IMQ (5%, 4 weeks), FU (0.5%) followed by the other treatments. The incremental cost per quality adjusted life year (QALY) for IMQ compared to CTx, showed that IMQ was dominant (less costly and more effective). Considering a willingness-to-pay threshold of 30,000/QALY, MAL-PDT and IMB would be considered cost-effective with respect to IMQ, and DCF would not be considered cost-effective with respect to IMQ.Findings need to be interpreted in the light of limitations (mainly variability across studies with respect to population, treatment procedure, follow-up times, and use of indirect comparison of active treatments due to scarcity of studies with direct comparisons).