This economic evaluation analyzed costs from a phase 3 multi-institutional RCT (the RADICAL trial) conducted in Australia, New Zealand, and Brazil. The study included 126 randomized patients with lentigo maligna, with 118 completing treatment (60 imiquimod, 58 radiotherapy). It compared topical imiquimod against radiotherapy, focusing on cost outcomes as the primary clinical trial showed no difference in treatment failure between the approaches.
From a healthcare system perspective, the cost per patient was US$72.50 for imiquimod versus US$2673.43 for radiotherapy. Radiotherapy also required far more treatment visits (27.39 vs 6.25). When including productivity loss and travel time (societal perspective), the cost difference remained large: US$697.94 for imiquimod versus US$4379.22 for radiotherapy. Safety, tolerability, and discontinuation data were not reported in this analysis.
Key limitations include that the analysis relied solely on Australian healthcare cost data and did not capture monetary impacts on retired patients. The authors note the underlying clinical trial was underpowered due to pandemic disruption. The practice relevance is that imiquimod represents a more cost-effective option for managing LM compared with radiotherapy in this specific economic model, but patient-centered shared decision-making should be prioritized given the clinical equipoise.
Researchers analyzed the costs of two different treatments for lentigo maligna, a type of skin condition. They compared topical imiquimod cream with radiotherapy in 126 patients from Australia, New Zealand, and Brazil. The study focused only on economic factors, not on which treatment worked better clinically.
From the healthcare system's perspective, imiquimod cost about $72 per patient while radiotherapy cost over $2,600. When including patient costs like travel time and lost productivity, imiquimod cost about $700 compared to nearly $4,400 for radiotherapy. Patients using imiquimod also needed far fewer treatment visits—about 6 versus 27 for radiotherapy.
There are important reasons to be careful with these results. The underlying clinical trial that provided the patient data was described as underpowered, meaning it might not have had enough participants to draw strong conclusions. The cost analysis used only Australian healthcare data, so costs would likely differ in other countries. The study also didn't account for how costs might affect retired patients.
Readers should understand this study shows imiquimod appears to be much less expensive than radiotherapy for treating lentigo maligna, but we need more research to be certain. The study doesn't tell us which treatment works better clinically—just that when they work similarly, one costs much less. Patients should discuss both treatment options and their costs with their doctors.
What this means for you: Imiquimod cream costs much less than radiotherapy for lentigo maligna, but more research is needed to confirm these findings.
View Original Abstract ↓
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.
