Department of Dermatology, Hospital Costa del Sol, Marbella, España.
J Eur Acad Dermatol Venereol. 2010 Dec;24(12):1431-6. doi: 10.1111/j.1468-3083.2010.03664.x.
Superficial basal cell carcinoma (sBCC) and Bowen's disease (BD) are usually slow-growing, low-grade malignancies that mainly affect older persons. Surgery is often the first choice of treatment and the modality with the lowest failure rate. However, non-invasive procedures, such as topical methyl aminolevulinate photodynamic therapy (MAL-PDT) and imiquimod, are increasingly demanded by dermatologists and patients, because of their generally favourable efficacy and adverse effects profile and their excellent cosmetic outcome.
To assess the cost of MAL-PDT and of treatment with imiquimod for primary non-melanoma superficial cutaneous carcinomas compared with conventional surgery, thereby calculating the total medical cost, and the direct and indirect costs.
We collected data on 67 patients with 86 tumours (32 sBCC, 54 BD). Patients were treated between May 2006 and April 2007 at the Dermatology Department of the Costa del Sol Hospital in Marbella, Spain. The mean cost and mean cost per complete clinical response were calculated for each therapeutic option.
After 2 years of follow-up, a complete response was observed in 89.5% of the MAL-PDT group, 87.5% of the imiquimod group and 97.5% of the surgery group. The difference in costs when compared with the surgery group was a mean saving per lesion treated of 307 euros for the imiquimod group, and 322 euros for the MAL-PDT group.
Although surgery proved to be more effective treatment, our results suggest that its average cost is greater than that of non-invasive therapy for the treatment of non-melanoma superficial cutaneous carcinomas on the lower limbs, at least after the first 2 years of follow-up.
浅表基底细胞癌（sBCC）和 Bowen 病（BD）通常是生长缓慢、低级别恶性肿瘤，主要影响老年人。手术通常是首选治疗方法，其失败率最低。然而，皮肤科医生和患者越来越多地要求使用非侵入性程序，如局部氨甲基酮戊酸光动力疗法（MAL-PDT）和咪喹莫特，因为它们具有良好的疗效和不良反应谱，以及极佳的美容效果。
评估 MAL-PDT 和咪喹莫特治疗原发性非黑素瘤浅表皮肤癌与传统手术相比的成本，从而计算总医疗成本以及直接和间接成本。
我们收集了 2006 年 5 月至 2007 年 4 月在西班牙马尔贝拉科斯塔德尔索尔医院皮肤科治疗的 67 例 86 个肿瘤（32 例 sBCC，54 例 BD）患者的数据。计算了每种治疗选择的平均成本和每个完全临床反应的平均成本。
在 2 年的随访后，MAL-PDT 组、咪喹莫特组和手术组的完全缓解率分别为 89.5%、87.5%和 97.5%。与手术组相比，咪喹莫特组和 MAL-PDT 组的每个病变治疗的平均成本分别节省 307 欧元和 322 欧元。
尽管手术被证明是更有效的治疗方法，但我们的结果表明，在至少前 2 年的随访后，其平均成本大于非侵入性治疗下肢非黑素瘤浅表皮肤癌的成本。
