Retinoblastoma treatment burden and economic cost: impact of age at diagnosis and selection of primary therapy

Hassan A Aziz,¹ Charlotte E LaSenna,² Michael Vigoda,^1,2 Cristina Fernandes,² William Feuer,¹ Mohammed Ali Aziz-Sultan,² Timothy G Murray<sup>1–3

1</sup>Bascom Palmer Eye Institute, Miami, FL, USA; ²University of Miami, Miami, FL, USA; ³Murray Ocular Oncology & Retina, Miami, FL, USA

Purpose: To follow the treatment history of patients with retinoblastoma to identify the trends in the number of hospital visits over time and the direct cost of medical care as determined by age at diagnosis and selected primary treatment modality.
Design: An Institutional Review Board (IRB) approved consecutive retrospective case series.
Materials and methods: Records from the Bascom Palmer Eye Institute were reviewed to identify 115 eligible patients (176 eyes) with retinoblastoma who underwent treatment at the Ocular Oncology Service between 1995 and 2010 and were available for extended follow-up evaluation.
Results: Bilateral disease was present in 53% (N = 61) of all patients, and 79% (N = 90) of patients were diagnosed in the first six months of life. Chemotherapy was used to treat 75% (N = 86) of all patients and 95% (N = 36) of patients diagnosed in the first six months of life. 100% (N = 4) of patients presenting between the age of five and nine were enucleated. Per episode of care, the lowest-cost treatment strategy was enucleation, followed by focal laser therapy, systemic chemotherapy with planned enucleation, systemic chemotherapy, and lastly, intra-arterial melphalan chemotherapy.
Conclusion: Age at diagnosis is directly associated with the type of treatment chosen for retinoblastoma. The burden of retinoblastoma treatment on children and families is significant. The direct medical cost of intra-arterial chemotherapy per episode of care is comparable to systemic chemotherapy, but current strategies utilizing multiple planned episodes of intra-arterial chemotherapy are significantly more costly and may be associated with less systemic side effects and similar favorable outcomes. At the Bascom Palmer Eye Institute, intra-arterial chemotherapy has quickly become the treatment of choice for globe conserving therapy of retinoblastoma.

Keywords: retinoblastoma, melphalan, intra-arterial chemotherapy, cost