Cost of early-stage mycosis fungoides treatments in Spain

Abstract

Aim

To identify the most common therapeutic options for the treatment of early-stage mycosis fungoides in Spain, quantify their associated healthcare resource use and costs.

Methods

After reviewing the literature, a panel of 6 Spanish clinical dermatologists validated the treatments and healthcare resource use through a structured questionnaire. Individual responses were collected, analyzed and presented into a face-to-face meeting in order to reach a consensus. Cost categories considered were: drug acquisition and administration, photo/radiotherapy session and maintenance, clinical follow-up visits and laboratory tests. Costs were expressed in euros from 2018. The Spanish National Health System perspective was considered, taking into account direct health costs and time horizons of 1, 3 and 6 months.

Results

Costs for the skin-directed treatments (SDT) assessed at 1, 3 and 6 months, were: Topical carmustine [€6,593.36, €19,780.09 and €27,592.78]; Phototherapy with psoralens and ultraviolet A light (PUVA) [€1,098.68, €2,999.99 and €3,187.60]; Narrow-band ultraviolet B phototherapy [€1,657.47, €4,842.10 and €4,842.10]; Total skin electron beam therapy (TSEBT) [€6,796.45, €7,913.34 and €7,913.34]. Cost for topical corticosteroids, being considered an adjuvant option, were €17.16, €51.49 and €102.97. Costs for the assessed systemic treatments alone or in combination with SDT at 1, 3 and 6 months, were: Systemic retinoids [€2,026.03, €5,206.63 and €7,426.42]; Systemic retinoids + PUVA phototherapy [€3,066.50, €8,271.26 and €10,046.58]; Interferon alfa + PUVA phototherapy [€1,541.09, €5,167.57 and €6,404.55].

Conclusion

According to the Spanish clinical practice, phototherapies in monotherapy were the treatments with the lowest associated costs regardless of the time horizon considered. TSEBT turned out as the treatment with the highest associated costs when considering 1 month. However, while considering 3 and 6 months the treatment with the highest associated costs was topical carmustine. The results of this analysis may provide critical information to measure the disease burden, to detect unmet medical needs and to advocate towards better treatments for this rare disease.

Keywords:

• health care costs
• health resources
• mycosis fungoides
• lymphoma
• T-cell
• cutaneous
• surveys and questionnaires
• Spain

Abbreviations

AEDV, Spanish Academy for Dermatology and Venerology; EORTC, European Organization for Research and Treatment of Cancer; IFNα, interferon alfa; ISCL, International Society for Cutaneous Lymphomas; CR, complete response; CTCL, cutaneous T-cell lymphomas; MF, mycosis fungoides; PUVA, psoralens with ultraviolet A light; SDT, skin-directed treatments; TSEBT, total skin electron beam therapy; NB-UVB, narrowband ultraviolet B light.

Acknowledgment

This manuscript includes information presented at the European Organisation for Research and Treatment of Cancer – Cutaneous Lymphoma Task Force annual meeting, September 2018, in St. Gallen, Switzerland and published as a congress abstract at the following site: https://www.ejcancer.com/article/S0959-8049(18)31295-4/fulltext.

Author contributions

All authors contributed to data analysis, drafting or revising the article, gave final approval of the version to be published, and agree to be accountable for all aspects of the work.

Disclosure

PLOR, OS, MTE, RMIB, RFdM and FG are, respectively, employed by Hospital 12 de Octubre, Hospital Universitari de Bellvitge, Hospital Clínic, Hospital de Basurto, Hospital Universitario Nuestra Señora de Candelaria and Parc de Salut Mar-Hospital del Mar. NLM and APM are employees of Oblikue Consulting, an independent contract health economic organization which received consultancy fees from Actelion Pharmaceuticals España S.L. and Helsinn Healthcare SA to conduct this research. The funding body was not involved in the study design, collection and interpretation of data, or in the decision to publish. PLOR has reported consultancy, participation to advisory boards and research support from Actelion Pharmaceuticals, Kyowa Kirin International, Takeda, and 4SC. PLOR also reports personal fees from Actelion and Helsinn, during the conduct of the study; personal fees from 4SC, Takeda, Miragen, Innate Pharma, Kyowa, Ricordati Rare Diseases, non-financial support from Meda, and a patent with PLCG1, outside the submitted work. OS reports personal fees, non-financial support from Takeda, personal fees from Kiowa kirim and Actelion, outside the submitted work. FG, NLM and APM received fees related to this study from Actelion Pharmaceuticals España S.L. and Helsinn Healthcare SA, during the conduct of the study. The authors report no other conflicts of interest in this work.