Photodynamic Therapy for Actinic Keratoses: A Randomized Prospective Non-sponsored Cost-effectiveness Study of Daylight-mediated Treatment Compared with Light-emitting Diode Treatment

Abstract

Daylight-mediated photodynamic therapy (DL-PDT) is considered as effective as conventional PDT using artificial light (light-emitting diode (LED)-PDT) for treatment of actinic keratoses (AK). This randomized prospective non-sponsored study assessed the cost-effectiveness of DL-PDT compared with LED-PDT. Seventy patients with 210 AKs were randomized to DL-PDT or LED-PDT groups. Effectiveness was assessed at 6 months. The costs included societal costs and private costs, including the time patients spent in treatment. Results are presented as incremental cost-effectiveness ratio (ICER). The total costs per patient were significantly lower for DL-PDT (€132) compared with LED-PDT (€170), giving a cost saving of €38 (p = 0.022). The estimated probabilities for patients' complete response were 0.429 for DL-PDT and 0.686 for LED-PDT; a difference in probability of being healed of 0.257. ICER showed a monetary gain of €147 per unit of effectiveness lost. DL-PDT is less costly and less effective than LED-PDT. In terms of cost-effectiveness analysis, DL-PDT provides lower value for money compared with LED-PDT.

The safety and efficacy of daylight photodynamic therapy in the treatment of actinic keratoses: a systematic review and meta‐analysis

“…The higher the score, the stronger the pain intensity. Pooled data across all eight studies, comprising 424 patients, revealed a lower level of pain in the patients who underwent DLPDT than in those who underwent CPDT ( n = 424; SMD, −2.544; 95% CI, −3.57 to −1.632; P < 0.001; Fig. ), suggesting a positive effect associated with DLPDT treatment of AKs with respect to pain.…”

“…Next, we read the entire texts of the remaining 22 studies in detail, of which 14 were discarded because they lacked the required outcome, contained duplicate data, or had not employed a test for randomness. Finally, eight articles comprising 424 patients were found to be suitable for this meta‐analysis and bias analysis . A flow diagram of our search strategy is shown in Figure .…”

“…Secondly, most of the comparisons showed significant heterogeneity, but we failed to perform further subgroup analysis to determine the potential sources of heterogeneity, owing to the lack of detailed information in the individual studies. Thirdly, the selected trials incorporated various design flaws, such as a lack of blinding in two of the studies; moreover, only one included study was double‐blinded. As in most cases, clinicians and patients could not be blinded to the treatment group, there was a potential for observer bias in determining outcomes.…”

“…to be suitable for this meta-analysis and bias analysis. [14][15][16][17][24][25][26][27] A flow diagram of our search strategy is shown in Figure 1.…”

“…[14][15][16][17]24,25,27 In the selected studies, all patients were aged >60 years, and the majority were male. All eight studies included the follow-up time, five studies included reports on the skin phototype (I/II/III), 14,16,[24][25][26] and three studies described the number of lesions treated (case/control). 14,24,27 Risk of bias in the results of each study was assessed by Cochrane Collaboration's tool, as shown in Figure 2.…”