Cost of early-stage mycosis fungoides treatments in Spain

Figures & data

Figure 1 Study diagram.

Abbreviations: CTCL, cutaneous T-cell lymphomas; MF, mycosis fungoides.

Table 1 Unit costs

Concept	Unit cost (€, 2018)			Source
	Base case	Minimum scenario	Maximum scenario
Pharmaceutical costs
Acitretin OR (mg)	0.05	0.04	0.06	^40
Alitretinoin OR (mg)	0.96	0.48	1.43
Beclomethasone TP (g)	0.05	0.04	0.08
Betamethasone TP (g)	0.07	0.05	0.09
Bexarotene OR (mg)	0.14	0.11	0.16
Carmustine IV (100 mg vial)	1,405.00	1,124.00	1,686.00
Clobetasol TP (g)	0.08	0.07	0.10
Diflorasone TP (g)	0.08	0.06	0.09
Statins OR (tablet)^a	0.11	0.11	0.12
Fenofibrate OR (tablet)	0.18	0.18	0.22
Fluocinolone TP (g)	0.12	0.04	0.24
Fluticasone TP (g)	0.15	0.12	0.18
IFNα (MIU)	3.96	3.82	4.11
Isotretinoin OR (mg)	0.04	0.04	0.04
Levothyroxine OR (tablet)	0.04	0.02	0.07
Methylprednisolone TP (g)	0.16	0.14	0.19
Mometasone TP (g)	0.08	0.08	0.08
Triamcinolone TP (g)	0.30	0.19	0.39
Imaging and laboratory tests
Complete biochemistry	91.41	29.32	182.88	^41
ANA level	27.39	15.00	38.01
Calcium/vitamin D level	31.07	12.26	42.88
Cortisol level	9.58	6.16	14.00
Creatinine level	2.84	0.48	7.30
Liver function test^b	22.92	5.01	63.88
Thyroid function test^c	24.95	15.23	43.32
Hemogram analysis	4.44	3.25	5.36
Blood triglycerides and cholesterol levels	6.91	1.19	15.10
Lymphoid phenotype	58.69	24.00	107.06
Phototest/photopatch	85.81	78.00	94.25
Chest X-ray	25.97	9.15	84.00
CT scan of abdomen and pelvis	254.19	62.00	484.88
Pregnancy test	8.38	5.00	11.30
Visit and clinical assessments
Specialist consultation, initial	121.18	26.00	245.99	^41
Consultations with specialist, successive	86.46	25.52	150.95
Ophthalmology review	51.55	47.00	56.09
Following psychiatric review	47.91	26.00	82.00
Treatment consultations
PUVA session	87.37	44.00	151.96	^41
NB-UVB session	136.08	44.00	195.25
TSEB session	312.09	311.26	312.93
Other costs
Parenteral administration (day hospital)^d	30.51	19.09	41.93	^42
Annual maintenance of phototherapy equipment	18.29	14.63	21.95	^43
Hospital pharmacy service pharmacist, compounding pharmaceutical (h)	27.32	24.04	32.78	^44
Hospital pharmacy service assistant, compounding pharmaceutical (h)	16.60	14.61	19.92	^44
Ethanol 96 (mL)	0.03	0.02	0.03	^40
Sterilized/White petroleum jelly (g)	0.10	0.04	0.29	^40
Vacuflasc^® 500 mL sterile flask (unit)	5.51	4.41	6.61	^45
Needles (unit)	0.12	0.04	0.22	^46
Absorbent sterile cotton gauze (unit)	0.06	0.05	0.06	^40
Gloves (unit)	0.04	0.00	0.07	^47

Notes: ^aConsidering equivalent usage distribution between atorvastatin 10 mg/day and simvastatin 20 mg/day. ^bIncludes the following assessment: aspartate aminotransferase, alanine amino transferase, gamma glutamyl transferase, alkaline phosphatase, bilirubin, albumin and prothrombin time. ^cIncludes the following assessments: thyroxine and thyrotropin ^dConsidering the partial attribution method.

Abbreviations: ANA, antinuclear antibodies; IFNα, interferon alfa; IV, intravenous; MIU, million international units; OR, oral; PUVA, psoralens with ultraviolet A light; TSEB, total skin electron beam; CT, computerized axial tomography scan; TG, triglycerides; TP, topical; NB-UVB, narrowband ultraviolet B light.

Table 2 Estimated costs for skin-directed treatments

	Base case		Minimum scenario		Maximum scenario
	€, 2018	%	€, 2018	%	€, 2018	%
Topical carmustine
Time horizon: 1 month
Pharmaceutical costs	6,582.28	99.83%	2,408.77	99.90%	10,791.71	99.79%
Lab tests and follow-up visits costs	11.09	0.17%	2.34	0.10%	22.80	0.21%
Total cost	6,593.36	100.00%	2,411.12	100.00%	10,814.51	100.00%
Time horizon: 3 months
Pharmaceutical costs	19,746.83	99.83%	2,408.77	99.90%	32,375.13	99.79%
Lab tests and follow-up visits costs	33.27	0.17%	2.34	0.10%	68.41	0.21%
Total cost	19,780.09	100.00%	2,411.12	100.00%	32,443.54	100.00%
Time horizon: 6 months
Pharmaceutical costs	27,546.37	99.83%	2,408.77	99.90%	64,750.27	99.79%
Lab tests and follow-up visits costs	46.41	0.17%	2.34	0.10%	136.81	0.21%
Total cost	27,592.78	100.00%	2,411.12	100.00%	64,887.08	100.00%
PUVA phototherapy
Time horizon: 1 month
Phototherapy sessions costs	949.13	86.39%	477.98	88.83%	1,980.91	85.05%
Lab tests and follow-up visits costs	148.03	13.47%	58.90	10.95%	346.25	14.87%
Associated maintenance costs	1.52	0.14%	1.22	0.23%	1.83	0.08%
Total cost	1,098.68	100.00%	538.10	100.00%	2,328.99	100.00%
Time horizon: 3 months
Phototherapy sessions costs	2,847.39	94.91%	1,390.84	95.70%	5,942.72	94.41%
Lab tests and follow-up visits costs	148.03	4.93%	58.90	4.05%	346.25	5.50%
Associated maintenance costs	4.57	0.15%	3.55	0.24%	5.49	0.09%
Total cost	2,999.99	100.00%	1,453.29	100.00%	6,294.46	100.00%
Time horizon: 6 months
Phototherapy sessions costs	3,034.70	95.20%	1,390.84	95.70%	8,205.84	95.87%
Lab tests and follow-up visits costs	148.03	4.64%	58.90	4.05%	346.25	4.05%
Associated maintenance costs	4.87	0.15%	3.55	0.24%	7.58	0.09%
Total cost	3,187.60	100.00%	1,453.29	100.00%	8,559.67	100.00%
NB-UVB phototherapy
Time horizon: 1 month
Phototherapy sessions costs	1,632.51	98.49%	631.91	97.05%	2,186.80	98.64%
Lab tests and follow-up visits costs	23.43	1.41%	18.00	2.76%	28.38	1.28%
Associated maintenance costs	1.52	0.09%	1.22	0.19%	1.83	0.08%
Total cost	1,657.47	100.00%	651.13	100.00%	2,217.01	100.00%
Time horizon: 3 months
Phototherapy sessions costs	4,814.17	99.42%	1,276.00	98.42%	6,560.40	99.49%
Lab tests and follow-up visits costs	23.43	0.48%	18.00	1.39%	28.38	0.43%
Associated maintenance costs	4.49	0.09%	2.46	0.19%	5.49	0.08%
Total cost	4,842.10	100.00%	1,296.46	100.00%	6,594.27	100.00%
Time horizon: 6 months
Phototherapy sessions costs	4,814.17	99.42%	1,276.00	98.42%	8,747.20	99.59%
Lab tests and follow-up visits costs	23.43	0.48%	18.00	1.39%	28.38	0.32%
Associated maintenance costs	4.49	0.09%	2.46	0.19%	7.32	0.08%
Total cost	4,842.10	100.00%	1,296.46	100.00%	8,782.89	100.00%
TSEBT
Time horizon: 1 month
Radiotherapy sessions costs	6,279.56	92.39%	4,303.19	97.45%	8,171.01	86.43%
Lab tests and follow-up visits costs	516.89	7.61%	112.66	2.55%	1,283.25	13.57%
Total cost	6,796.45	100.00%	4,415.84	100.00%	9,454.26	100.00%
Time horizon: 3 months
Radiotherapy sessions costs	7,395.28	93.45%	5,124.05	97.84%	9,638.17	88.23%
Lab tests and follow-up visits costs	518.06	6.55%	113.00	2.16%	1,285.28	11.77%
Total cost	7,913.34	100.00%	5,237.05	100.00%	10,923.46	100.00%
Time horizon: 6 months
Radiotherapy sessions costs	7,395.28	93.45%	5,124.05	97.84%	9,638.17	88.23%
Lab tests and follow-up visits costs	518.06	6.55%	113.00	2.16%	1,285.28	11.77%
Total cost	7,913.34	100.00%	5,237.05	100.00%	10,923.46	100.00%
Topical corticosteroids
Time horizon: 1 month
Pharmaceutical costs	16.33	95.16%	4.49	92.94%	76.71	98.24%
Lab tests and follow-up visits costs	0.83	4.84%	0.34	7.06%	1.37	1.76%
Total cost	17.16	100.00%	4.83	100.00%	78.09	100.00%
Time horizon: 3 months
Pharmaceutical costs	49.00	95.16%	13.47	92.94%	230.14	98.24%
Lab tests and follow-up visits costs	2.49	4.84%	1.02	7.06%	4.12	1.76%
Total cost	51.49	100.00%	14.50	100.00%	234.26	100.00%
Time horizon: 6 months
Pharmaceutical costs	97.99	95.16%	26.95	92.94%	460.29	98.24%
Lab tests and follow-up visits costs	4.98	4.84%	2.05	7.06%	8.24	1.76%
Total cost	102.97	100.00%	28.99	100.00%	468.53	100.00%

Abbreviations: PUVA, psoralens with ultraviolet A light; NB-UVB, narrowband ultraviolet B light; TSEBT, total skin electron beam therapy.

Table 3 Estimated costs for systemic treatments alone or in combination with skin-directed treatments

	Base case		Minimum scenario		Maximum scenario
	€, 2018	%	€, 2018	%	€, 2018	%
Systemic retinoids
Time horizon: 1 month
Pharmaceutical costs	1,495.16	73.80%	367.28	76.61%	2,660.22	63.75%
Lab tests and follow-up visits costs	530.87	26.20%	112.13	23.39%	1,512.43	36.25%
Total cost	2,026.03	100.00%	479.40	100.00%	4,172.65	100.00%
Time horizon: 3 months
Pharmaceutical costs	4,485.47	86.15%	367.28	76.61%	7,980.66	78.86%
Lab tests and follow-up visits costs	721.16	13.85%	112.13	23.39%	2,139.45	21.14%
Total cost	5,206.63	100.00%	479.40	100.00%	10,120.12	100.00%
Time horizon: 6 months
Pharmaceutical costs	6,572.46	88.50%	367.28	76.61%	15,961.33	83.82%
Lab tests and follow-up visits costs	853.96	11.50%	112.13	23.39%	3,079.99	16.18%
Total cost	7,426.42	100.00%	479.40	100.00%	19,041.32	100.00%
Systemic retinoids in combination with PUVA phototherapy
Time horizon: 1 month
Pharmaceutical costs (retinoids, OR)	1,983.69	64.69%	1,442.15	84.91%	2,474.47	47.04%
Phototherapy sessions costs	522.02	17.02%	119.49	7.04%	1,238.07	23.53%
Lab tests and follow-up visits costs	559.27	18.24%	135.62	7.98%	1,546.25	29.39%
Associated maintenance costs	1.52	0.05%	1.22	0.07%	1.83	0.03%
Total cost	3,066.50	100.00%	1,698.48	100.00%	5,260.62	100.00%
Time horizon: 3 months
Pharmaceutical costs (retinoids, OR)	5,951.06	71.95%	4,326.45	89.02%	7,423.41	55.75%
Phototherapy sessions costs	1,566.07	18.93%	358.48	7.38%	3,714.20	27.89%
Lab tests and follow-up visits costs	749.56	9.06%	171.70	3.53%	2,173.28	16.32%
Associated maintenance costs	4.57	0.06%	3.66	0.08%	5.49	0.04%
Total cost	8,271.26	100.00%	4,860.29	100.00%	13,316.38	100.00%
Time horizon: 6 months
Pharmaceutical costs (retinoids, OR)	7,304.31	72.70%	5,310.27	89.42%	9,111.47	56.72%
Phototherapy sessions costs	1,922.18	19.13%	440.00	7.41%	4,558.80	28.38%
Lab tests and follow-up visits costs	814.47	8.11%	184.01	3.10%	2,387.15	14.86%
Associated maintenance costs	5.61	0.06%	4.49	0.08%	6.73	0.04%
Total cost	10,046.58	100.00%	5,938.77	100.00%	16,064.16	100.00%
IFNα in combination with PUVA phototherapy
Time horizon: 1 month
Pharmaceutical costs (IFNα)	429.21	27.85%	413.55	40.96%	704.92	25.58%
Administration costs (IFNα)	397.72	25.81%	248.85	24.65%	546.59	19.83%
Phototherapy sessions costs	512.27	33.24%	257.98	25.55%	1,069.15	38.79%
Lab tests and follow-up visits costs	200.37	13.00%	88.15	8.73%	433.61	15.73%
Associated maintenance costs	1.52	0.10%	1.22	0.12%	1.83	0.07%
Total cost	1,541.09	100.00%	1,009.75	100.00%	2,756.10	100.00%
Time horizon: 3 months
Pharmaceutical costs (IFNα)	1,358.94	26.30%	1,309.36	38.95%	2,632.24	27.02%
Administration costs (IFNα)	1,193.16	23.09%	746.56	22.21%	1,639.76	16.83%
Phototherapy sessions costs	2,410.53	46.65%	1,213.93	36.11%	5,030.96	51.64%
Lab tests and follow-up visits costs	200.37	3.88%	88.15	2.62%	433.61	4.45%
Associated maintenance costs	4.57	0.09%	3.66	0.11%	5.49	0.06%
Total cost	5,167.57	100.00%	3,361.65	100.00%	9,742.06	100.00%
Time horizon: 6 months
Pharmaceutical costs (IFNα)	1,676.07	26.17%	1,614.91	38.78%	3,289.64	27.13%
Administration costs (IFNα)	1,464.48	22.87%	916.32	22.01%	2,012.64	16.60%
Phototherapy sessions costs	3,058.02	47.75%	1,540.00	36.98%	6,382.32	52.64%
Lab tests and follow-up visits costs	200.37	3.13%	88.15	2.12%	433.61	3.58%
Associated maintenance costs	5.61	0.09%	4.49	0.11%	6.73	0.06%
Total cost	6,404.55	100.00%	4,163.87	100.00%	12,124.95	100.00%

Abbreviations: IFNα, interferon alfa; OR, oral; PUVA, psoralens with ultraviolet A light.

Figure 2 Cost of the main alternative treatments in managing the early stages of MF in Spain.

Abbreviations: IFNα, interferon alfa; PUVA, psoralens and ultraviolet A light; TSEBT, total skin electron beam therapy; NB-UVB, narrow-band ultraviolet B light.