Impact of Topical Fluorouracil Cream on Costs of Treating Keratinocyte Carcinoma (Nonmelanoma Skin Cancer) and Actinic Keratosis

Publication date: Available online 2 March 2018
Source:Journal of the American Academy of Dermatology
Author(s): Jean Yoon, Ciaran S. Phibbs, Adam Chow, Martin A. Weinstock
BackgroundIt is unknown whether treatment costs of Keratinocyte Carcinoma (KC) and Actinic Keratosis (AK) can be lowered by spending more on chemoprevention.ObjectiveWe examine the impact of one-course treatment of topical fluorouracil on the face and ears on KC and AK treatment costs over three years.MethodsThe VAKCC trial compared the efficacy of topical fluorouracil cream, 5%, vs vehicle control cream for reducing KC risk. Trial data and administrative data on costs and utilization were analyzed to measure post-randomization encounters and treatment costs for KC and AK care. Adjusted models were used to test for statistically significant differences between treatment arms for number of treatment encounters and costs.ResultsOne year after randomization, the control arm had higher mean number of treatment encounters for SCC (0.04) than the intervention arm (0.01) (P<0.01). At one year the intervention arm had lower treatment and dermatologic costs of $2,106 (SD=$2,079) compared to $2,444 (SD=$2,716) for control patients (P=0.02). After three years, the intervention arm incurred $771 less per patient.LimitationsCare not provided or paid by VA was not included. Results may not be generalizable to other payers.ConclusionWe found significant cost savings for patients treated with 5-FU.