Surgical versus Medical Treatment of Ocular Surface Squamous Neoplasia: A Cost Comparison

PURPOSE

The objective of this study was to compare the cost associated with surgical versus interferon-alpha 2b (IFNα2b) treatment for ocular surface squamous neoplasia (OSSN).

DESIGN

A matched, case-control study.

PARTICIPANTS

A total of 98 patients with OSSN, 49 of whom were treated surgically and 49 of whom were treated medically.

METHODS

Patients with OSSN treated with IFNα2b were matched to patients treated with surgery on the basis of age and date of treatment initiation. Financial cost to the patient was calculated using 2 different methods (hospital billing and Medicare allowable charges) and compared between the 2 groups. These fees included physician fees (clinic, pathology, anesthesia, and surgery), facility fees (clinic, pathology, and operating room), and medication costs. Time invested by patients was calculated in terms of number of visits to the hospital and compared between the 2 groups. Parking costs, transportation, caregiver wages, and lost wages were not considered in our analysis.

MAIN OUTCOME MEASURES

Number of clinic visits and cost of therapy as represented by both hospital charges and Medicare allowable charges.

RESULTS

When considering cost in terms of time, the medical group had an average of 2 more visits over 1 year compared with the surgical group. Cost as represented by hospital charges was higher in the surgical group (mean, $17 598; standard deviation [SD], $7624) when compared with the IFNα2b group (mean, $4986; SD, $2040). However, cost between the 2 groups was comparable when calculated on the basis of Medicare allowable charges (surgical group: mean, $3528; SD, $1610; medical group: mean, $2831; SD, $1082; P = 1.00). The highest cost in the surgical group was the excisional biopsy (hospital billing $17 598; Medicare allowable $3528), and the highest cost in the medical group was interferon ($1172 for drops, average 8.0 bottles; $370 for injections, average 5.4 injections).

CONCLUSIONS

Our data in this group of patients previously demonstrated equal efficacy of surgical versus medical treatment. In this article, we consider costs of therapy and found that medical treatment involved two more office visits, whereas surgical treatment could be more or equally costly depending on insurance coverage.

The cost of ipilimumab toxicity: a single-centre analysis

There are no published data on the costs associated with investigating and managing toxicity from ipilimumab treatment in patients with metastatic melanoma. Patients treated with ipilimumab at The Royal Marsden Hospital between 1 September 2010 and 1 April 2013 were identified. Data on demographics, investigations and survival outcomes were collected. Patients with grade 3 or higher immune-related adverse events were identified, and costs of investigating and managing toxicities in them were calculated on the basis of standard National Health Service tariffs. Out of the 110 patients, 29 experienced grade 3/4 immune-related adverse events. The total cost of investigating and managing these patients was £140,680, or a median cost of £2860 per patient. Patients experiencing grade 3/4 toxicities had 1-, 2- and 3-year survival rates of 79, 59 and 46%, compared with 24, 17 and 15% in the group that did not experience significant toxicity (P<0.0005). The most common treatment-related toxicity identified was colitis. Two patients died from complications associated with ipilimumab colitis. The cost of ipilimumab toxicity is marginal in comparison with the total treatment cost. Patients treated with ipilimumab who develop significant toxicity have a higher than expected 1-, 2- and 3-year survival.

Impact of an education program on late diagnosis of retinoblastoma in Honduras

BACKGROUND

In developed countries, more than 90% of children with retinoblastoma present with limited-stage disease and are cured; however, in countries with limited resources, like Honduras, most patients present with advanced disease and cure rates are less than 50%. Early diagnosis is necessary to improve the survival of children with retinoblastoma in these countries.

PROCEDURE

We describe the preliminary results of a retinoblastoma education program linked to a national vaccination campaign in Honduras. Posters and flyers were designed to be accessible to poorly educated readers, to convey the severity of retinoblastoma, and to provide contact information. Charts and an electronic database were reviewed to determine age at diagnosis, presenting signs and symptoms, date of diagnosis, and outcome.

RESULTS

During the eight previous years (July 1995-June 2003), 73% of the 59 diagnosed cases of retinoblastoma were extraocular; in contrast, during the post-campaign period (June 2003-January 2005), only 35% of the 23 diagnosed cases showed extraocular spread (P = 0.002). More than one-third of patients in both time periods either refused therapy or abandoned treatment.

CONCLUSION

This inexpensive approach is an effective first step toward improving survival of childhood retinoblastoma. Abandonment and refusal of therapy are continuing obstacles.

Socioeconomic impact of modern multidisciplinary management of retinoblastoma

OBJECTIVE

Our objective for this study was to examine the impact of the modern management of intraocular retinoblastoma on the patient and the family.

METHODS

This study comprises a retrospective, noncomparative case series of 25 consecutive patients with multifocal, intraocular retinoblastoma that was treated with primary systemic chemotherapy. Medical charts were reviewed, and the following data were extracted: patients' age and gender, laterality of disease, and Reese-Ellsworth classification of each eye as well as the number of central venous lines placed, cycles of chemotherapy received, outpatient appointments, examinations under anesthesia, focal therapies administered, computed tomography/MRI, radiation treatments, anesthetic procedures administered, and miles traveled.

RESULTS

Twenty patients with bilateral and 5 with unilateral intraocular retinoblastoma (median age: 9.3 months) had 895 outpatient appointments and underwent 698 examinations under anesthesia with 230 focal therapies, 347 days of radiotherapy, 226 computed tomography scans/MRIs, and 38 central venous line placements. A total of 1272 anesthetic procedures (median: 50) were performed with no major complication. In all, patients traveled 822312 miles (median: 22214 miles) to receive their care. The median follow-up was 82 months.

CONCLUSIONS

Successful retinoblastoma management requires close surveillance, aggressive consolidation, and numerous anesthetic procedures, all of which the patients and the families must endure. There is a significant impact on the patient, the family, and hospital resources.