Mai-Jun - Sociedade Brasileira de Oftalmologia

Periocular basal cell carcinoma: cost of topical immunotherapy versus estimated cost of surgical treatment183DISCUSSIONMalignant eyelid tumors constitute an importantpart of clinical ophthalmology. At our institution, surgeryis still the treatment of choice, except in patients withhigh surgical risk, multiple lesions or refusal to submit tosurgery for aesthetic or psychological reasons. Suchpatients may opt for immunotherapy with 5% imiquimodcream. Knowledge of treatment costs is an essentialsubsidy to the financial planning of health careinstitutions.Aguilar et al. evaluated the cost of treatment forsuperficial BCC in the lower limbs. Surgery was found tobe more costly, but also more efficacious, than clinicaltreatment. (11)Vanaclocha et al. evaluated the cost-effectivenessof treatment of superficial BCC using surgical excision or5% imiquimod cream at dermatological and nondermatologicalservices and found that clinical treatmentreduced patient cost compared to surgery. (12) In addition,the cost was higher at non-dermatological services due tomore expensive surgical procedures and postoperative care.Surgical treatment was less costly in our study thanin the literature. However, the duration of surgery andneed of supplies may have been underestimated by thefact that estimates were based on image analysis.Nevertheless, we believe that even if corrected for thisdifference, surgery would still be significantly lessexpensive than immunotherapy, especially in view ofthe low fixed labor costs of Brazilian public institutions.The cost of clinical treatment was similar to whathas been reported from other countries, but prolongedtreatment would be financially unfeasible in the contextof Brazilian public health care. The possibility of reducingclinical cost to the level of surgical cost through bulkpurchase of less expensive but equivalent brands ofmedication might be explored in future studies.5. Gupta AK, Browne M, Bluhm R. Imiquimod: a review. J CutanMed Surg. 2002;6(6):554-60.6. Peris K, Campione E, Micantonio T, Marulli GC, Fargnoli MC,Chimenti S. Imiquimod treatment of superficial and nodularbasal cell carcinoma: 12-week open-label trial. Dermatol Surg.2005;31(3):318-23.7. Schön MP, Schön M. Immune modulation and apoptosis induction:two sides of the antitumoral activity of imiquimod.Apoptosis. 2004;9(3):291-88. Macedo EM , Carneiro RC, Matayoshi S. Imunoterapia tópicano tratamento do carcinoma basocelular periocular. Rev BrasOftalmol. 2009;68(6):355-8.9. Kara-Junior N, de Santhiago MR, Kawakami A, CarricondoP, Hida WT. Mini-rhexis for white intumescent cataracts. Clinics(Sao Paulo). 2009;64(4):309-12.10. Kara-José Junior N, Avakian A, Lower LMT, Rocha AM,Cursino M, Alves MR. Facoemulsificação versus extração extracapsularmanual do cristalino: análise de custos. Arq BrasOftalmol. 2004;67(3):481-9.11. Aguilar M, de Troya M, Martin L, Benítez N, González M. Acost analysis of photodynamic therapy with methylaminolevulinate and imiquimod compared with conventionalsurgery for the treatment of superficial basal cell carcinomaand Bowen’s disease of the lower extremities. J Eur AcadDermatol Venereol. 2010;24(12):1431-6.12. Vanaclocha F, Daudén E, Badía X, Guillén C, Conejo-Mir JS,Sainz de Los Terreros M, Hamel L, Llorens MA; HEIS StudyGroup. Cost-effectiveness of treatment of superficial basalcell carcinoma: surgical excision vs. imiquimod 5% cream. BrJ Dermatol. 2007;156(4):769-71.Corresponding author:Erick Marcet Santiago de MacedoRua Dr. Veiga Filho, n° 207, apto. 59, CEP 01229-001- São Paulo, (SP), Brazile-mail: erickmarcet@yahoo.com.brREFERENCES1. Wong CS, Strange RC, Lear JT. Basal cell carcinoma. BMJ.2003;327(7418):794-8. Review.2. Allali J, D’Hermies F, Renard G. Basal cell carcinomas of theeyelids. Ophthalmologica. 2005;219(2):57-71. Review.3. Cook BE Jr, Bartley GB. Treatment options and future prospectsfor the management of eyelid malignancies: an evidence-basedupdate. Ophthalmology. 2001;108(11):2088-98;quiz 2099-100, 2121.4. Hamada S, Kersey T, Thaller VT. Eyelid basal cell carcinoma:non-Mohs excision, repair, and outcome. Br J Ophthalmol.2005;89(8):992-4. Comment in Br J Ophthalmol.2006;90(5):660-1. Br J Ophthalmol. 2006;90(7):926; authorreply 926-7.Rev Bras Oftalmol. 2012; 71 (3): 180-3