A new skin cancer finding from VA’s Keratinocyte Carcinoma Chemoprevention Trial Group found a new intervention with a cream treatment could save $700 per veteran over the course of three years with a savings of $69 million in aggregate.

ClinicalTrials.gov published the following detailed description of the study:

Basal cell carcinoma (BCC) and squamous cell carcinoma (SCC) of the skin, both of which are keratinocyte carcinomas (KCs), account for a half of all cancers in the United States, and over 100,000 diagnoses per year in the VA. The standard treatment for these KCs is excision of the lesion, and they cost the US health care system some $2.5 billion annually and about $100 million annually in the VA. There is no proven means to prevent KCs (except perhaps for a modest benefit of intensive daily sunscreen use). An effective prevention strategy would dramatically change the way high-risk patients are managed and could substantially reduce the costs of care. The investigators’ preliminary analysis indicates that the savings will be $116 per high-risk patient and will account for a total national savings of over $11 million. These findings imply that the study would pay for itself by the end of 4 years. The investigators hypothesize that topical 5-fluorouracil (5-FU) chemoprevention will prevent skin cancer surgeries and will be cost-saving. To test this the investigators propose a randomized controlled trial of 5-FU compared to a vehicle control to the face and ears in a high-risk population.

In the study, 1000 Veterans at high-risk of skin cancer defined as at least 2 KCs in the prior 5 years, at least one of which was on the face or ears, will be randomized to 5-FU or a vehicle control cream, and followed for 2 to 4 years. The primary endpoint will be surgery for any KC on the face and ears. The investigators will also assess the cost of care, quality of life, the side effects associated with treatment, and the prevalence and number of actinic keratoses, a skin cancer precursor and itself a cause of morbidity and cost. By targeting patients at high-risk, the study focuses on high-cost patients for whom this treatment could both improve outcomes (cancers and quality of life) and reduce costs.

Study Results

Excerpt from the Journal of the American Academy of Dermatology:

One year after randomization, the control arm had a higher mean number of treatment encounters for squamous cell carcinoma (0.04) than the intervention arm (0.01) (P < .01). At 1 year, the intervention arm had lower treatment and dermatologic costs: $2106 (standard deviation, $2079) compared with $2444 (standard deviation, $2716) for the control patients (P = .02). After 3 years, the intervention arm incurred a cost of $771 less per patient.

VA Article Summarizing Finding

From the VAntage Point blog:

A recent VA study has revealed an effective, cost-efficient method for the prevention of nonmelanoma skin cancer, the most common cancer in the U.S. Investigators at the VA Palo Alto Health Care System discovered that, over a three-year period, patients treated with topical fluorouracil 5% (5-FU) had decreased skin cancer-related health care costs. Results suggest 5-FU could reduce the development of nonmelanoma skin cancer (and the related condition, actinic keratosis) in high-risk patients. With around 90,000 Veterans being treated for nonmelanoma skin cancer and treatment costs approaching $5 billion annually, the calculated cost savings of 5-FU therapy for VA could be as high as $69 million within three years.

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I’m curious to hear from anyone with an experience in a study of this type or who might benefit from the drug.

Source: https://www.jaad.org/article/S0190-9622(18)30344-X/fulltext

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18 COMMENTS

  1. Sounds like the VA just rediscovered that thing we call in the 1st World as ‘Sunscreen’, and the VA’s version will be repurposing spent uranium mixed with Titanium in rediscovered ‘Sunscreen’.

    Is it the sun burning or is it the VA’s newly rediscovered ‘Sunscreen’ burning?

    Answer: Both, would be correct. Uranium & Titanium rhyme as well, fulfilling VA’s need for goobly-gooky names that twist/contort the tongue to where your tongue just gives-up like the VA’s “Keratinocyte Carcinoma Chemoprevention Trial Group” does to my tongue.

    This seems to be all about saving the VA $$$$, not so much about saving Veteran’s lives. But the VA *did* just rediscover Sunscreen….

  2. This reminds me of the Arch of the Covenent where the government puts it in a large wooden crate and files it in a warehouse with to be hidden forever. Years ago the VA in St. Louis devises a cataract treatment where they removed the bad eye lens and instead of inserting an artificial lens injected a polymer lens replacement that hardened to the consistency of a human lens. This lens actually worked with the eye muscles for perfect focus. This should have become the gold standard of cataract surgery.
    To this day the VA is still using the fixed lens replacement, which is suboptimal. The injecteale lens would have made the veteran have the vision of a 20-year old. Although this was a quantum improvement, it never saw the light of day. I waited for years to get in line with this discovery, but it was never released. I even wrote a complaint to Shenseki to no avail. The VA Technology Group is only chartered to find a public company to commercialize such discoveries, but can not do it itself. One year J&J nibbled, but no product. I guess this discovery did not meet the max profit motive of the medical industry although it was a quantum advancement. I bet this happens with many VA discoveries. It is probably in a crate next to the Arch of the Covenant never to be seen again. This is the way of American medicine.

    • I must have died somewhere along the line and came-to living in hell, Indiana. Not a damn thing is going correctly or decently around here.

      I read about this injection process during some research about cataracts. An article from Japan or Paris I think it was. No such thing here. My simple or claimed cataract lasik turned into seemingly another costly scam. No mere ten minute or so in office procedures here, with costs around two grand per eye. Turned into patients going to out patient surgery at a local hospital costing instead of a stated couple thousand bucks per eye, if not ordering special lenses to stop use of glasses, into a twenty grand plus. Four hours surgery prep for ten minute procedures?

      Plus the swap. I wasn’t informed about some side issues that may happen. Ahhh no problem, “we fix.” No worry bout udder problems. For me it was cataracts for constant and permanent floaters today. Oh and severe dry eye. At least I can night drive now, cataracts gone, and read/type until the eyes say no more. OR have to wait until the eyes want to cooperate with my daily wants or needs. Then informed only a small percentage of people this happens to like around 30% by some reports? Glad I didn’t waste or go into debt the extra six thousand for lenses I could throw glasses out over many claims of ‘no worry.”

  3. “It puts the lotion on it’skin, or it gets the hose again’– “Silence Of The Lambs”

    • “It puts the lotion on it’skin” and then it blisters off. But with the Neurological damage being acute central nervous system damage. It should hurt to much after the first few weeks.

      • Dam misspellings being changed by the spell checker. The last sentence should read ( I shouldn’t hurt to much after the first few weeks.”

      • It shouldn’t hurt to much after the first few weeks.

        __________

        Need another pot of coffee.

  4. From reviewing a number of sites on the web regarding the use of Fluorouracil. Long term use of Fluorouracil is a kin to suicide by VA Health Care. Although there may be a reduced cost of treating keratinocyte carcinoma (nonmelanoma skin cancer) and actinic keratosis. It is guaranteed to increase cost to treat the side effects. Including cardio problems.

    No doubt the use of this new VA sun screen containing Fluorouracil will definitely insure treatment for the side effects will be required. Health care which will likely triple the cost and seriously reduce the health and wellness in Veterans who are submitted to this Human Subject Research.

    Several of the common side effects:

    Cardiotoxicity — Cardiotoxicity is a fairly common side effect, but usually this cardiotoxicity is just angina or symptoms associated with coronary artery spasm, but in about 0.55% of those receiving the drug will develop life-threatening cardiotoxicity. Life-threatening cardiotoxicity includes: arrhythmias, ventricular tachycardia and cardiac arrest, secondary to transmural ischaemia

    Mood disorders (irritability, anxiety, depression)

    “Neurological damage — 5-FU(Fluorouracil) injection and topical application, even in small doses, cause both acute central nervous system (CNS) damage and progressively worsening delayed degeneration of the CNS in mice. This latter effect is caused by 5-FU-induced damage to the oligodendrocytes that produce the insulating myelin sheaths.”

    This from Wikipedia regarding the side effects of Fluorouracil.

    Before considering being a guinea pig at the VA and using this shit you really need to check out the very hazardous side effects if not then happy blistering. Wikipedia has them at: “https://en.wikipedia.org/wiki/Fluorouracil”

    • I’m thinking the VA’s version would also have to have an agent orange barrel tint to it, so it will also be marketed as a defoliant and a bug spray…

      • cj ¯¯̿̿¯̿̿’̿̿̿̿̿̿̿’̿̿’̿̿̿̿̿’̿̿̿)͇̿̿)̿̿̿̿ ‘̿̿̿̿̿̿\̵͇̿̿\=(•̪̀●́)=o/̵͇̿̿/’̿̿ ̿ ̿̿

        VA’s new million Veteran sun screen skeeter beater cardiotoxicity neuro personality disorder generator…………..all claims DENIED……..next.

    • The VA here didn’t care about severe side effects from anything. From SSRIs, oh we have to add a kicker for it work properly, Al something, and another SSRI, Trazadone, etc. Making issues worse. Then getting a midnight call from one MD telling me what meds to immediately stop taking since I now have NAFatty liver. But had to bicker with the every revolving door of local PCPs at the local CBOC about my history and what I was told. Then after leaving the VA to encounter the same kind of crap with civy care only calling it different names like instead of Gabapentin giving me Neurontin or something that is the exact same thing, different labeling and name. Then in the ending of the VA game told in the ‘new pain clinic’ that we’d be asked, forced, to sign special contracts that would allow the VA to take over our lives completely and “allowing” them to “force” us to take SSRIs or anything else they’d demand we try again or lose VA care. Report this to people all they want is a copy of said contract which I didn’t stick around to see or sign. Others at that orientation said they’d have no other choice but to sign it once it was presented in later pain clinic group meetings.

      Just more VA, college kiddy, med school projects and research BS. Someone got an A for class projects.

      I also have my own negative story about undergoing Basal Cell surgery at the VA. Finally went well enough, cut out, but the side issues and signing another paper just before being put under and never getting a requested copy of it and told them I had already signed releases for everything and the anesthesiologist were done. Last I heard of it, questions ignored.

  5. In other news the VA has also implemented the use of the new “smarter pills” designed to stimulate cognitive thinking. While critics claim those pills are simply round rabbit droppings the VA counters that the organic matrix is perfect for delivering the cognitive boosts.

    In tests vets were not told that the “pills” were rabbit dung and just that the pills were “smarter pills”. In tests subjects 84% of the subjects spit the pills out violently exclaiming, “Hey, that’s rabbit shit!” VA concludes these men became smarter from investing the pills as proven by their reaction and plans to roll the program out nation wide for TBI victims with cognitive deficits.

    At VA, they do for all that which nobody can do for themselves. Chew on that…

    • Do your “Smart Pills” come in PEZ Dispensers shaped like bunnies or only real bunnies? Fun vs. Furry packaging?

  6. I have been using Va prescribed Fluorouicil periodically for 10 years to knock down small actinic lesions.
    What else is new?

  7. Might be ok,if can teach diagnostics. Have several with one bad and another really bad and rare. Kept asking. To have a scab check that was there 8 months after removal. They asked the doctor to look at when came for appointment.said nothing to worry about and just a small scab and that was it. Didn’t ask anyone or look up, since a rare form of skin cancer called Infiltrating Basil Cell Carcinoma. One one the rarest, the small scab? It grows under the skin and could be deep and larger than a quarter under the skin and can travel to lymph nodes. They changed my pcp without notice again putting through an anxiety show, of course a kid which just finished residency and is a know it all ass. VA changed my brand of meds, which last time almost killed me. Tell this kid doctor and without asking a question or my history said nothing to worry about. So complained on Friday and seen a doctor up the chain who is recommending going on the brand with no problems, especially that the VA could get and young docs needs to write script for the outside which I must pay myself. I guess he didn’t the message and home in pain with withdrawals. I have never seen so much stench in the air with arrogance, I’m sure will get around in a week or two.

  8. I cant logically see 5 FU’s saving 69 million. Besides, its only a drop in the bucket when we talk about 6 BILLION they currently spend. A good program analysis could cut the bureaucracy and save that much without any “new” drug.

  9. I just had Basel Cell scraped off my leg and face by a private sector Dermatologist. I’ve been showing it to VA for over a year. They were calling it pressure ulcers.

Comments are closed.