title: Surgical versus Medical Treatment of Ocular Surface Squamous Neoplasia: A Cost Comparison.
abstract: OBJECTIVE
  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).
  
  
  METHODS
  A matched, case-control study.
  
  
  METHODS
  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.
  
  
  METHODS
  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.
authors.affiliation: Bascom Palmer Eye Institute, University of Miami, Miami, Florida.
authors.forename: Christina S
authors.initials: CS
authors.lastname: Moon
authors.affiliation: Bascom Palmer Eye Institute, University of Miami, Miami, Florida.
authors.forename: Afshan A
authors.initials: AA
authors.lastname: Nanji
authors.affiliation: Bascom Palmer Eye Institute, University of Miami, Miami, Florida; Miami Veterans Affairs Medical Center, Miami, Florida.
authors.forename: Anat
authors.initials: A
authors.lastname: Galor
authors.affiliation: Department of Public Health Sciences, University of Miami, Miami, Florida.
authors.forename: Kathryn E
authors.initials: KE
authors.lastname: McCollister
authors.affiliation: Bascom Palmer Eye Institute, University of Miami, Miami, Florida. Electronic address: ckarp@med.miami.edu.
authors.forename: Carol L
authors.initials: CL
authors.lastname: Karp
mesh_terms: D000287:Administration, Topical; D000368:Aged; D000369:Aged, 80 and over; D002278:Carcinoma in Situ / Q000191:economics* / Q000628:therapy; D002294:Carcinoma, Squamous Cell / Q000191:economics* / Q000628:therapy; D016022:Case-Control Studies; D003230:Conjunctival Neoplasms / Q000188:drug therapy / Q000191:economics* / Q000601:surgery / Q000628:therapy; D003316:Corneal Diseases / Q000188:drug therapy / Q000191:economics* / Q000601:surgery / Q000628:therapy; D017281:Cost of Illness; D005134:Eye Neoplasms / Q000188:drug therapy / Q000191:economics / Q000601:surgery / Q000628:therapy; D005260:Female; D017721:Hospital Costs; D006801:Humans; D007155:Immunologic Factors / Q000191:economics*; D000077190:Interferon alpha-2; D016898:Interferon-alpha / Q000191:economics*; D008297:Male; D006278:Medicare / Q000191:economics; D008875:Middle Aged; D009883:Ophthalmic Solutions; D013508:Ophthalmologic Surgical Procedures / Q000191:economics*; D011994:Recombinant Proteins / Q000191:economics; D012189:Retrospective Studies; D014481:United States
chemical_list: D007155:Immunologic Factors; D000077190:Interferon alpha-2; D016898:Interferon-alpha; D009883:Ophthalmic Solutions; D011994:Recombinant Proteins