Local radiation and phototherapy are the most cost-effective treatments for stage IA mycosis fungoides: A comparative decision analysis model in the United States

Fan Di Xia, Bart S. Ferket, Victor Huang, Robert S. Stern, Peggy A. Wu

Research output: Contribution to journalArticlepeer-review

4 Scopus citations

Abstract

Background: Treatments for early-stage mycosis fungoides (MF) include topical steroids, topical nitrogen mustard, topical bexarotene, narrowband ultraviolet B (NBUVB), psoralen plus ultraviolet A (PUVA), and local radiation. The relative cost-effectiveness of each treatment given the differences in treatment failure, disease progression, and therapy escalation is not established. Objective: To compare the cost-effectiveness (CE) of treatment options for stage IA MF. Methods: A state-transition model was constructed with health states of stage IA to stage IV disease, no MF, and death. Treatment-specific remission and relapse rates were obtained from the literature. Lifetime costs were calculated by accounting for medications, office visits, laboratory monitoring, related procedures, work absences, and travel. Results: The order of CE of the study treatments was determined to be as follows: local radiation, $225,399 for 15.40 life-years (LYs); NBUVB, $344,728 for 15.17 LYs; PUVA, $371,741 for 15.07 LYs; topical corticosteroids, $469,354 for 14.65 LYs; topical nitrogen mustard, $951,662 for 14.29 LYs; and topical bexarotene, 11,892,496 for 13.55 LYs. Sensitivity analyses confirmed the CE rankings. Limitations: We assumed a constant probability of response, relapse rates, and 3-month treatment intervals. Conclusions: Local radiation is the most cost-effective treatment for limited local disease, whereas phototherapy (NBUVB or PUVA) is cost-effective for generalized disease. Our findings can serve to inform future studies and recommendations regarding selection of therapy for stage IA MF.

Original languageEnglish
Pages (from-to)485-492.e4
JournalJournal of the American Academy of Dermatology
Volume80
Issue number2
DOIs
StatePublished - Feb 2019

Keywords

  • cost-effectiveness
  • mycosis fungoides
  • stage IA
  • treatment

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