Surgical Costs of Enucleation Versus Plaque Brachytherapy for Intraocular Malignancy: A Time-Driven Activity-Based Costing Approach

•Time-driven activity-based costing analysis of enucleation versus brachytherapy.•Plaque brachytherapy is significantly more costly than enucleation.•Primary cost drivers are cost of the plaque and radiation oncology expenses.•Further studies needed to tie quality-of-life measures to cost effectiveness. To compare costs between enucleation and plaque brachytherapy procedures for the treatment of intraocular malignancies. Retrospective economic analysis using a time-driven activity-based costing (TDABC) methodology. Patients undergoing plaque brachytherapy and enucleation procedures for the treatment of intraocular malignancy performed at the University of Michigan Kellogg Eye Center from 2021-2022. Data inputs were obtained from the Electronic Health Record (EHR) and prior literature. Associated expenses were determined using TDABC, a method for cost calculation that correlates the cost rate of each resource used in a procedure with the amount of time that the resource is used. The primary outcome was the difference in total cost associated with enucleation versus plaque brachytherapy procedures. Secondary outcomes included length of surgery (in minutes), total day-of-surgery costs, and number of follow-up visits. 145 cases were included, with 41 enucleations and 104 courses of plaque brachytherapy. Between all enucleation and plaque brachytherapy procedures, plaque brachytherapy was significantly more costly ($10,140.95 versus $6,127.70, P < .01), with total difference in cost of $4013 (95% confidence interval $3352.02 to $4674.47). There was no significant difference in OR time between enucleation and plaque brachytherapy. Plaque brachytherapy required significantly more follow-up visits than enucleation (1.02 visits versus 0.59 visits, P < .01). Through TDABC cost analysis, we determined that the surgical course of plaque brachytherapy is more costly than enucleation, with the primary cost drivers being cost of the radiotherapy plaque and radiation oncology-related expenses.