Oral nicotinamide (vitamin B3) may provide a cost-effective strategy for preventing keratinocyte carcinoma (KC) in persons at high risk, according to a study published in JAMA Dermatology. Led by David Perez, BA, the study was designed to determine whether the clinical benefits previously observed with nicotinamide translate into economic value for health-care systems and patients. The investigators found that nicotinamide reduced KC incidence while lowering overall treatment costs and improving quality-adjusted life-years (QALYs).
Study Details
Keratinocyte carcinoma, ie, non-melanoma skin cancer, which includes basal cell carcinoma and cutaneous squamous cell carcinoma, is the most common cancer in the United States and places a substantial burden on patients and health-care systems. Previous clinical studies have shown that oral nicotinamide (at 500 mg twice daily) reduces the development of new KCs, but its cost-effectiveness had not previously been evaluated.
Using data from the Veterans Health Administration, the investigators conducted a 1-year economic analysis comparing patients who received nicotinamide for at least 30 days vs those who did not. The analysis included 33,822 veterans with a history of one or more KCs, including 12,287 patients exposed to nicotinamide (mean age = 77.2 years) and 21,535 who were unexposed (mean age = 76.9 years). A total of 98.0% of participants were male in both cohorts. The researchers incorporated treatment costs for KC procedures, annual nicotinamide expenses, and estimates of QALYs gained. The primary endpoint was the annual number of KC events prevented, translated into QALYs.
Key Findings
During 78,726 person-years of follow-up, the incidence of KC was 0.204 events per person-year among nicotinamide users vs 0.255 events per person-year among nonusers, representing an absolute reduction of 0.051 events per person-year. This translated into an estimated 624 KCs prevented annually among the 12,287 patients receiving nicotinamide and a number needed to treat of approximately 20 patients for 1 year to prevent one KC.
From an economic perspective, annual nicotinamide costs totaled $161,451, whereas reduced treatment requirements generated an estimated $526,032 in savings, resulting in a net savings of $364,581. Based on an assumed quality-of-life decrement of 0.01 QALY per KC, nicotinamide use produced 6.24 QALYs gained across the cohort, corresponding to an incremental cost-effectiveness ratio of –$58,426 per QALY gained. Overall, yearly KC treatment expenditures were reduced by nearly 20%. Even when civilian cost assumptions were applied, nicotinamide remained cost-effective, with an estimated differential cost of $14,407 per QALY gained.
The authors concluded: “In this economic evaluation, oral nicotinamide was a cost-effective and patient-centric preventive approach for KC, particularly in [male] individuals with KC history at high risk of multiple primary KCs.”
Rebecca I. Hartman, MD, MPH, of the Department of Dermatology, Brigham and Women’s Hospital, Boston, is the corresponding author for the JAMA Dermatology article.
DISCLOSURE: The study was funded by the U.S. Department of Defense and the U.S. Department of Veterans Affairs. For full disclosures of the study authors, visit jamanetwork.com.
