Transcript Slide 1

MM Update on Actinic Keratosis
and Emollients
Rachel Mackay
Head of Medicines Management
G&W CCG
Established Treatments
Efudix® (Fluorouracil 5%) - Decision made May 2009
Aldara® (Imiquimod 5%) – decision made Oct 2009
The committee agreed that both Efudix and Aldara should be a RED drug on
the traffic light system if initiated following an out-patient appointment by a
secondary care specialist / GPSI as the cost of the drug is included within PbR
tariff.
GPs may make an individual clinical decision to prescribe for recurrent
conditions and where they have sufficient knowledge/experience and feel
that a referral to a specialist has not been necessary on that occasion
Solaraze® (diclofenac 3%) – Never had a status given to it
Proposed treatment options discussed and agreed at
PCN 29/11/13
Ingenol mebutate gel (Picato®) - Green
Fluorouracil 0.5% / salicylic acid 10% (Actikerall®) - Green
N.B. The above should be considered RED if patient referred to Acute Trust as the
whole treatment course is to be supplied if considered appropriate at the outpatient
appointment.
The PCN does not support the routine use of Imiquimod 3.75% cream (Zyclara®) for
actinic keratosis and it should be considered as BLACK on the traffic light system.
The PCN supports the use of Aminolaevulinic acid (Ameluz® 78mg/g gel) for Actinic
Keratosis as a RED drug on the traffic light system as an option for the treatment of
actinic keratosis of mild to moderate intensity on the face & scalp when photodynamic
therapy is considered appropriate.
Ameluz should only be administered under the supervision of a physician, a nurse or
other healthcare professionals experienced in the use of photodynamic therapy.
Cost per treatment cycle of topical treatments for AK
Treatment
Formulation
Price
Course length
Price per
course of
treatment
£77.00
Solaraze®
(Diclofenac 3%)
Gel
50g = £38.30
12 weeks
Aldara® (Imiquimod
5%)
Cream
12 x 250mg single
use sachets
= £48.50
12 weeks
£97.00
Efudix®
(Fluorouracil 5%)
Cream
40g = £32.83
12 weeks
£33.00 to
£65.00
Actikerall®
(5-FU/SA)
Solution
25ml = £38.30
12 weeks
£77
Picato®▼ (Ingenol
mebutate)
Gel
500 microgram/g
2-tube pack or
150microgram/g
3-tube pack = £65
2 or 3 days
depending on
area
£65.00
Zyclara®
(imiquimod 3.75
Cream
%) 28 x 250mg
sachet = £113
6 weeks
£226
A maximum of
56 sachets
could be used
per treatment
period
Doses are for
general
comparison and
do not imply
therapeutic
equivalence.
Costs are based on
treating a 25cm2
area for 12 weeks.
Annual expenditure for G&W CCG for
12/13 on AK products
•
Solaraze ® (Diclofenac 3%) gel) - £35,484
•
Aldara® (Imiquimod 5%) - £2,037
•
Efudix® (Fluorouracil 5%) - £4,894
•
Actikerall® (Fluorouracil 0.5% / salicylic acid 10%) - £601
•
Picato® (Ingenol mebutate) gel - £0
•
Zyclara® (Imiquimod 3.75% cream) - £0
•
Total - £43,017
Pathway Development
Local guidelines to be produced
alongside training to enable patients
to receive more treatment for AK in
primary care thus reducing referrals
utilising the Primary Care Dermatology
Society (Sept 2012) Treatment
Pathway for AK to inform this work.
Primary Care Dermatology Society
Guidelines Sept 2012
The PCDS recommend that diclofenac 3% is used to treat Grade I lesions, or
if this is not suitable then 5-FU, imiquimod 5% or 5-FU/SA.
Grade II lesions should preferably be treated with 5-FU/SA, imiquimod 5%
or 5-FU.
The treatments are not recommended for use in primary care for treating
grade III lesions. 5-FU, imiquimod 5% and diclofenac 3% can all be used to
treat field changes.
These guidelines do not include the use of imiquimod 3.75% or ingenol
mebutate, which have only been available since the beginning of 2013.
8 Preferred emollients
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Aquamax cream
Cetraben cream
Zerobase cream
Zerocream
Zeroguent cream
Emulsifying ointment
Zeroderm ointment
50:50 liquid and white soft paraffin
Black on traffic light (not routinely recommended for
prescribing):
Aqueous cream, Diprobase cream, E45 cream,
Hydromol ointment, Epaderm ointment, Unguentum M cream
Aqueous cream BP
Not recommended as a leave-on emollient or
soap substitute.
Why?
• Poor emollient
• Tendency to cause irritant reactions
• More cost effective products available
Aquamax® cream is a suitable alternative