Treatment Patterns and Patients’ Pathways in Actinic Keratosis Population: A Retrospective Longitudinal Cohort Study in the French National Health Insurance Claim Database (SNDS)—EPIKA Study

OBJECTIVES: The objectives of this study were to describe patients treated for actinic keratosis (AK) in France and their management. Further objectives will be to estimate the rate of progression to squamous cell carcinoma and identify the factors associated with this progression.

METHODS: EPIKA study is a retrospective study based on the SNDS, exhaustive medico-administrative claim database which covers 99% of the French population. The study included a random sample of patients aged ≥40 years with treated AK identified in the database between 01/01/2012 and 31/12/2019. Patients treated for AK were included in the study at the time of their first identified treatment for AK in the database, following a period of ≥2 years without any AK-related treatment (index date). All patients were followed up to 31/12/2021, allowing a two-years follow-up for the last included patients.

RESULTS: Out of 618,175 patients treated for AK identified in the database, 286,085 were randomly selected for this study. Extrapolating to the general population, this suggests that 1.7% of patients aged ≥40 years were treated for AK in France. 56.5% of patients were male (n=161,707) with a median age of 73 years [range:40.0-108.0]. Patients had a median of 5.5 years of follow-up [IQR:3.8-7.5]. Of those, 211,715 received their first treatment for AK during the follow-up period, 88.9% received at least one topical treatment lasting on average 50.2±40.9 days (prescribed for 83.1% by a dermatologist and for 23.0% by a general practitioner); 15.3% photodynamic therapy, 51.4% of the patients had undergone at least one cryotherapy session, 54.5% a cutaneous biopsy (44.1% by a dermatologist) and 52.2% surgery (73.1% by a dermatologist).

CONCLUSIONS: The EPIKA study reveals that 89% of AK patients received topical treatments and 52% underwent surgical procedures. This study allows for further characterisation of AK management and identification of the determinants of skin cancer development over time.