Ok, Efudex [5-fluorouracil] is the "older" treatment and is available for about $36 per goodrx. It requires up to 4 weeks of application. The
American Cancer society web page says 5-FU is
The drug most often used in topical treatment of actinic keratoses, as well as some basal and squamous cell skin cancers, is 5-FU (with brand names such as Efudex, Carac, and Fluoroplex).
Here is the efficacy data from the package inserts:
5-FU complete clearance 48% [2 studies] and partial [75%] clearance 68% at 4 weeks
Picato complete 42% and partial clearance 64% at 57 days.
squamous-cell-skin-cancer/treating/other-than-
So nearly identical efficacy. Interestingly the Picato insert includes 1 year follow up data whereas the 5-FU does not. Here is the 12 months follow up
Based on 108 Picato® gel-treated subjects who achieved complete clearance in Study 1 and Study 2, the recurrence rate at 12 months was 54% where recurrence was defined as the percentage of subjects with any identified AK lesion in the previously treated area who achieved complete clearance at Day 57.
So if you don't mind applying the cream for a few weeks longer it looks from this data that you could save $$$ by switching to the lower cost med without loss of efficacy. Your dermatologist may have better data, but a medline search did find a review comparing published data on 5-FU/SA [
actikerall] vs IMB [picato] Note 5-FU/SA is not identical to 5-FU
Read it
HERE
Summary
Although qualitative assessment suggested a numerical advantage of 5-FU/SA over IMB .. in terms of complete clinical clearance and sustained clearance, clinical data from longer term trials, with comparable outcome measures, are required to corroborate these findings.