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Gokul Kumar, Steven Kymes, J William Harbour; A Cost-effectiveness Approach To Treatment Of Medium-sized Choroidal Melanomas. Invest. Ophthalmol. Vis. Sci. 2012;53(14):3400.
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The Collaborative Ocular Melanoma Study (COMS) established that treatment of medium-sized choroidal melanomas with Iodine-125 brachytherapy plaque and primary enucleation resulted in similar survival rates. Brachytherapy offers the opportunity to treat melanoma and preserve vision without adverse consequence on survival. Here, we analyze how the additional costs of brachytherapy are offset by the benefit of vision preservation versus primary enucleation.
We modeled a simulated cohort of people with medium-sized posterior choroidal melanomas in one eye. We then performed a cost-utility analysis with the use of a Markov model. The incremental cost-effectiveness ratio (ICER) was evaluated for a 5-year period following primary treatment.
The total approximate cost for brachytherapy treatment was $49685. The total cost for enucleation treatment was $34240. The quality adjusted life-years of enucleation was 3.83. The quality adjusted life-years for eyes preserved with brachytherapy was dependent on the utility loss from radiation retinopathy, a complication in a notable proportion of the treated cohort. Evaluation with annual utility loss range from 0.0-0.3 yielded an ICER range of $36,754/QALY to $389,705/QALY.
The ICER can be compared to a willingness-to-pay (WTP) threshold to determine whether a treatment is relatively cost-effective. Using a WTP of $100,000/QALY, our model predicts that brachytherapy would be cost-effective if the utility loss from radiation retinopathy is <0.21. At a higher level of utility loss from retinopathy (0.3), brachytherapy remains "cost-effective" if the proportion of patients who develop retinopathy is <17.5%. This suggests that I-125 brachytherapy for medium-sized choroidal melanoma can be "cost-effective" to society if the utility loss from radiation retinopathy can be minimized or if the proportion of patients who develop radiation retinopathy is below 17.5%.
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