Medicopolitical

Excimer lamp therapy deserves Medicare funding, clinicians say


Excimer lamp therapy should be subsidised under the MBS, according to dermatologists who have found that the narrowband UVB treatment is an effective and well tolerated option for about a third of patients with conditions such as vitiligo.

In a review of the outcomes of 2116 sessions of 308-nm excimer lamp therapy delivered to 62 patients at two tertiary centres, they found that its use was predominantly for vitiligo (91.9%) and hypopigmented disorders (4.8%), and with head and neck region the most frequently treated anatomical site (58%).

Overall, a marked response (≥75% repigmentation) was noted in 19% of patients at six months and 36% at 12 months, with 30.6% of patients overall achieving a ≥75% repigmentation over an average of 30 treatment sessions. In total, 82% of patients showed some clinical improvement.

For vitiligo patients, an average of 35 treatment sessions were needed to establish repigmentation. Moderate responses (≥50%) of repigmentation were achieved in 40.8% of patients, of whom 36.7% achieved a marked response of ≥75% repigmentation at the end of the treatment period.

Review authors led by Dr Janice Yeon of The Skin Hospital, Sydney, and Sydney University, noted that in their experience with excimer lamp therapy it was generally well tolerated. In their review of 62 patients, tender erythema and blistering were observed in 13 patients, and depigmentation following a burn in one patient. Adverse effects could be minimised by attention to device distance and dose increments, they said.

Quality of life and patient satisfaction were improved in most patients undergoing excimer lamp therapy, with Dermatology Life Quality Index (DLQI) scores reduced from a mean baseline score of 5.6to 3.3 after treatment (P < 0.001).

In real world practice they found that barriers to treatment included the costs and the inconvenience from time commitment needed to attend two to three times a week for excimer light therapy, with up to six sites treated per session. On patient satisfaction scores (PSQ-18) the two items with lowest rating were financial aspects (3.4 ± 1.2) and accessibility and convenience (3.5 ± 1.3).

In their audit they found that one third of patients (32%) decided to stop excimer lamp treatment due to affordability or time commitment issues, whereas 36% were discontinued by their dermatologist due to a lack of improvement or satisfactory repigmentation, whilst 18% continued treatment, and 8% were lost to follow-up.

With a cost of $50 per session and an average of 30 session over 12 months, the average out of pocket cost amounted to $1485 per year.

“Unlike phototherapy for whole-body/hand-and-foot cabinet, excimer therapy is not covered under the MBS,” the authors noted.

“A medical item number for excimer light therapy as a subsidised treatment under the MBS, when it is the preferred option of phototherapy for the condition being treated, should be considered … the addition of the excimer light therapy to the list of Medicare services subsidised by the Australian government would be a step in the right direction,” they concluded.

The findings are published in the Australasian Journal of Dermatology.

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