Ingenol mebutate gel is a new treatment of Actinic Keratosis (AK). The adverse effects of current AK drug treatment involve long-lasting local skin responses (LSRs) which may influence patient adherence negatively. OBJECTIVES: Assess patient´s willingness-to-pay (WTP) for accessing ingenol mebutate gel instead of imiquimod 5%, imiquimod 3.75% and diclofenac 3% in a US setting and assess patient´s likelihood of completing a full treatment course. METHODS: A web-survey (contingent valuation design) was sent to 2000 adults, including only AK diagnosed subjects with self-reported AK lesions on face/scalp and/or trunk/extremities, asking them their maximum WTP to receive access to ingenol mebutate gel instead of one of three alternative drugs.  The profile was varied in three dimensions; duration of treatment and treatment-related local skin responses and comparator price. Respondents were also asked to rank the likelihood to successfully complete treatment course. Internal validity was checked (hypothetical drug profile and income effect). RESULTS: A total of 116 subjects (105 useful) responded (response rate 53% if AK prevalence assumed to 11%). A total of 33% stated that they followed treatment instructions fairly well (75% of the time) or to some extent (50%), despite experience of LSRs. Almost 90 % rated ingenol mebutate gel as the treatment they were most likely to successfully complete; 50-63% were willing to pay extra (mean $475-518/course) to access ingenol mebutate gel instead of the three treatment alternatives. Subjects with experience of drug treatment stated an incremental WTP (mean $820/course) for accessing ingenol mebutate gel instead of imiquimod 3.75%. Subjects currently treating the full scalp or forehead stated an incremental WTP (mean $674 respectively $726/course) for accessing ingenol mebutate gel instead of imiquimod 5% and diclofenac 3%. CONCLUSIONS: There is a substantial dissatisfaction with current AK treatments and clear evidence that patients are willing to pay for shorter treatment and LSR duration.