Cost of early-stage mycosis fungoides treatments in Spain

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 [euro6,593.36, euro19,780.09 and euro27,592.78]; Phototherapy with psoralens and ultraviolet A light (PUVA) [euro1,098.68, euro2,999.99 and euro3,187.60]; Narrow-band ultraviolet B phototherapy [euro1,657.47, euro4,842.10 and euro4,842.10]; Total skin electron beam therapy (TSEBT) [euro6,796.45, euro7,913.34 and euro7,913.34]. Cost for topical corticosteroids, being considered an adjuvant option, were euro17.16, euro51.49 and euro102.97. Costs for the assessed systemic treatments alone or in combination with SDT at 1, 3 and 6 months, were: Systemic retinoids [euro2,026.03, euro5,206.63 and euro7,426.42]; Systemic retinoids + PUVA phototherapy [euro3,066.50, euro8,271.26 and euro10,046.58]; Interferon alfa + PUVA phototherapy [euro1,541.09, euro5,167.57 and euro6,404.55]. 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.