OBJECTIVES: Actinic keratosis is a chronic skin condition that may cause pain, itch and bleeding. It may also develop into squamous cell carcinoma if left untreated. Many of the active topical interventions are associated with substantial adverse event rates and/or require relatively long treatment courses. Tirbanibulin 1% is a recently launched 5-day course topical treatment for the face and scalp. Results of two phase III clinical trials indicate that tirbanibulin leads to significant improvements in the complete clearance of actinic keratosis lesions at 57 days (vs placebo). The aim was to estimate the cost-effectiveness of tirbanibulin, compared to the three most common topical therapies, from a Scottish perspective.

METHODS: A one-year decision tree model was developed to compare tirbanibulin with diclofenac sodium gel 3%, imiquimod cream 5%, and fluorouracil cream 5%. Patients were separated into two categories: successful and unsuccessful. Treatment was ‘successful’ if no clinically visible lesions remained at the end of the treatment period. The probability of complete clearance associated with each treatment was informed from a network meta-analysis. The probability of treatment-related adverse events (in the form of severe local skin reactions) were informed from a targeted literature search. The model captured direct medical costs associated with treatment acquisition, treatment-related adverse events and healthcare professional visits. Disutilities associated with actinic keratosis and local skin reactions were also captured.

RESULTS: Over a one-year time horizon tirbanibulin led to cost savings of £31.35, £76,16 and £92.84 versus diclofenac, imiquimod, and fluorouracil respectively. Additionally, tirbanibulin was dominant, as it was associated with negligibly higher quality-adjusted life years of approximately 0.005. Tirbanibulin also remained cost saving when model inputs were varied in sensitivity and scenario analyses.

CONCLUSIONS: Tirbanibulin is cost-saving and cost-effective for the treatment of actinic keratosis in Scotland when compared with the most commonly used topical therapies.