A cost comparison of radiotherapy and topical imiquimod for lentigo maligna treatment: Considerations for clinical decision-making

Background: Lentigo maligna (LM) is an in situ melanoma occurring on sun-damaged skin. Radiotherapy or topical imiquimod are potential alternatives to surgery; a recent randomized trial showed no difference in treatment failure between those approaches (underpowered because of pandemic disruption).

Objective: To conduct an economic evaluation comparing radiotherapy versus topical imiquimod for treating LM.

Methods: Based on no difference in clinical outcomes, a cost analysis was performed alongside the RADICAL trial, a multi-institutional randomized (1:1) phase 3 study (118/126 patients randomized completed treatment; 60 imiquimod and 58 radiotherapy) conducted in Australia, New Zealand, and Brazil. Direct medical costs and indirect costs (productivity loss and travel time) were estimated from health care system and societal perspectives.

Results: Health care system costs per patient were substantially higher for radiotherapy (US$2673.43) than imiquimod (US$72.50). Radiotherapy required more treatment visits than imiquimod (average, 27.39 vs 6.25) and resulted in greater productivity losses and travel time costs. Thus, from a societal perspective, radiotherapy costs totaled US$4379.22 versus US$697.94 for imiquimod.

Limitations: Analysis relied solely on Australian health care cost data and did not capture monetary impacts on retired patients.

Conclusion: Imiquimod represents a substantially more cost-effective treatment option for managing LM compared with radiotherapy. Patient-centered shared decision-making should be prioritized.