Ambulight PDT for the treatment of non-melanoma skin cancer

The manufacturer's cost analysis evaluated the costs of service configuration in which Ambulight PDT might be used, compared with conventional hospital-based PDT using a static lamp, for a complete treatment cycle, which consists of 2 treatments 1 week apart. In the cost analysis it was assumed that patients had already been diagnosed with non-melanoma skin cancer, so no costs associated with the diagnostic stage of management were included. The analysis did not include any costs associated with treatment efficacy or adverse events.

Four clinical scenarios were presented in which a GP with special interest in dermatology delivered PDT in the community with Ambulight PDT. These scenarios were presented for comparison against conventional hospital-based PDT using a static lamp:

• A GP operating in their own practice.

• A GP operating in a specialist centre.

• A GP operating in an outpatient clinic in secondary care.

• A nurse hybrid service model (nurses delivering treatment in the patient's home after diagnosis by a GP with specialist interest in dermatology).

The costs of the first 3 of these clinical scenarios for service delivery were calculated using the analysis of the potential economic impact of the NICE cancer service guidance CSGSTIM (2006 and 2010) on skin cancer. The manufacturer did not include overheads or GP costs for the nurse hybrid service model.

The cost analysis did not include any impact on staff costs for additional training or for support for patients. Patients may need support and advice because Ambulight PDT has the potential to be used while they continue with daily activities, outside a clinical setting.

There was significant uncertainty in the costs presented in the submission so it was difficult to determine the likely cost difference in practice. The cost difference between PDT using Ambulight PDT and conventional PDT using a static lamp presented in the manufacturer's submission ranged from a cost saving of £195 to a cost increase of £536. The cost difference was dependent on the clinical scenario used for delivering PDT with Ambulight PDT and the method of calculating the cost of each scenario.

The cost analysis presented cost savings associated with Ambulight PDT in the form of removing the need for staff to administer illumination from a static machine, room hire for the illumination period, and anaesthesia, which could translate into resource savings.

The committee considered that the cost models submitted by the manufacturer were complicated and difficult to interpret. The range of cost consequences was wide, with some showing an increase in cost to the service and others showing small savings. The committee was therefore unable to draw firm conclusions about the cost savings associated with using Ambulight PDT in the community.

The committee discussed the potential resource savings to the NHS from using Ambulight PDT in the community (see section 5.6). However, it is likely that the level of service provision for PDT already established in a community setting is a key factor in whether using Ambulight PDT might be associated with a cost saving or cost increase compared with conventional PDT with a static lamp. The committee was mindful of the additional costs involved in setting up the range of facilities to deliver PDT in the community, and was not convinced that the potential resource savings would confer sufficient advantage.