Keloids can cause physical impairment and cosmetic disfigurement resulting in diminished quality of life. Excision for keloids is usually indicated after failure to respond to conservative therapy and may be combined with radiation therapy (RT) or injections of triamcinolone (TAC) or fluorouracil (5-FU). Defining a cost-effective option may influence physician and payer decisions when determining future treatment methods. Modeling incremental cost-effectiveness ratios (ICERs) from the payer perspective can help to inform the decision-maker. A Markov model (disease free vs recurrence) was constructed from the perspectives of the Centers for Medicare and Medicaid Services (CMS) as well as an out-of-pocket US payer (OOP) to examine the cost-effectiveness of post-excisional interventions (RT vs TAC or 5-FU injection) in keloid patients, modeled for a 20-year period. Recurrence risk data was derived from the literature. Cost data was derived from Medicare Provider Utilization and Payment Data for 2012-2017. Disease-free years (DFY) were discounted 3% annually, and costs were accrued up-front. Probabilistic sensitivity analysis (PSA) and subsequent analysis for willingness-to-pay (WTP) thresholds were conducted. The ICERs and 90% credible intervals were $158/DFY ($73/DFY - $583/DFY) for CMS and $681/DFY ($304/DFY - $2526/DFY) for OOP. PSA-generated WTP thresholds were $170 for CMS and $728 for OOP. Although substantial uncertainty and variation exist in this model, radiation is a cost-effective treatment option for WTP greater than threshold values. Continuing work on this project intends to analyze cost-effectiveness in terms quality-adjusted life-years rather than disease-free years. Ongoing collection of patient-level data to apply health utility to the model will allow the results to be cross-comparable to other health interventions.