Abstract
Background: Brachytherapy is an emerging alternative treatment modality that is becoming increasingly widespread. It has demonstrated efficacy, with similar rates of recurrence and no significant difference in overall survival compared to enucleation and external beam radiotherapy. However, it offers the advantage of reducing the risk of eye loss, improving visual outcomes, and enhancing the overall quality of life for patients. Objective: To assess the economic evaluation of eye-plaque brachytherapy as a treatment option for intraocular melanoma in Thailand. Furthermore, we aim to evaluate the budgetary implications of incorporating eye-plaque brachytherapy into comprehensive health insurance coverage in Thailand. Methods: We conducted a cost-utility analysis to compare the cost-effectiveness of eye-plaque brachytherapy and eye enucleation in patients with intraocular tumors, with a focus on intraocular melanoma, which includes uveal melanoma and retinoblastoma. Our analysis utilized a Markov model and calculated the Incremental Cost-Effectiveness Ratio (ICER) to determine the additional cost per quality-adjusted life year gained (cost per QALY). Additionally, we performed a Budget Impact Analysis (BIA) to evaluate the financial implications of adopting this cost-effective treatment option within comprehensive health insurance coverage for all types of intraocular tumors. Results: In an incidence-based analysis, plaque brachytherapy emerged as a cost-effective treatment option for intraocular tumors. The Incremental Cost-Effectiveness Ratio (ICER) for plaque brachytherapy compared to total enucleation was 193,852 Thai Baht per (QALY. This ICER was found to be within the cost-effectiveness threshold for rare diseases in Thailand. In addition, when we analyzed the scenario with maximum healthcare system capacity, the ICER remained favorable at 133,648 Thai Baht per QALY gained. This indicates that plaque brachytherapy continues to be a cost-effective strategy, even under conditions of higher demand for treatment. Regarding the budget impact, adopting plaque brachytherapy for patients with intraocular melanoma and non-melanoma intraocular tumors would result in an annual budget impact of 2.28 million Thai Baht. This budget allocation covers both rare intraocular tumors and other very rare diseases, such as eye hemangioma, retinal vasoproliferative tumors, choroidal metastasis, retinal pigment epithelium adenoma, hemangioblastoma, leiomyosarcoma, von Hippel-Lindau, with estimated cases totaling fewer than 1 case per year. These findings suggest that including plaque brachytherapy in the national comprehensive health insurance system for the treatment of intraocular tumors, including uveal melanoma and retinoblastoma, as well as all other rare intraocular tumor types, is a beneficial and cost effectively. Conclusion: Our study suggests that plaque brachytherapy is cost-effective as a treatment option for intraocular tumors. It offers the potential to reduce eye loss and improve visual outcomes in patients with intraocular melanoma and other rare intraocular tumors while maintaining a budget impact of no more than 2.5 million Thai Baht per year.
