Cost-effectiveness of Mohs Micrographic Surgery vs Surgical Excision for Basal Cell Carcinoma of the Face.
OBJECTIVE
To assess the cost-effectiveness of Mohs micrographic surgery (MMS) compared with the surgical excision for both primary and recurrent basal cell carcinoma (BCC).


METHODS
A cost-effectiveness study performed alongside a prospective randomized clinical trial in which MMS was compared with surgical excision.


METHODS
The study was carried out from 1999 to 2002 at the dermatology outpatient clinic of the University Hospital Maastricht, Maastricht, The Netherlands.


METHODS
A total of 408 primary (374 patients) and 204 recurrent (191 patients) cases of facial BCC were included.


METHODS
The mean total treatment costs of MMS and surgical excision for both primary and recurrent BCC and the incremental cost-effectiveness ratio, calculated as the difference in costs between MMS and surgical excision divided by their difference in effectiveness. The resulting ratio is defined as the incremental costs of MMS compared with surgical excision to prevent 1 additional recurrence.


RESULTS
Compared with surgical excision, the total treatment costs of MMS are significantly higher (cost difference: primary BCC, 254 euros; 95% confidence interval, 181-324 euros; recurrent BCC, 249 euros; 95% confidence interval, 175-323 euros). For primary BCC, the incremental cost-effectiveness ratio was 29,231 euros, while the ratio for recurrent BCC amounted to 8094 euros. The acceptability curves showed that for these ratios, the probability of MMS being more cost-effective than surgical excision never reached 50%.


CONCLUSIONS
At present, it does not seem cost-effective to introduce MMS on a large scale for both primary and recurrent BCC. However, because a 5-year period is normally required to determine definite recurrence rates, it is possible that MMS may become a cost-effective treatment for recurrent BCC.
Essers
Brigitte A B
BA
Department of Clinical Epidemiology and Medical Technology Assessment, University Hospital Maastricht, The Netherlands. bes@kemta.azm.nl
Dirksen
Carmen D
CD
Nieman
Fred H M
FH
Smeets
Nicole W J
NW
Krekels
Gertrude A M
GA
Prins
Martin H
MH
Neumann
H A Martino
HA
D000368:Aged; D002280:Basal Cell Carcinoma / Q000191:economics* / Q000473:pathology / Q000601:surgery; D003362:Cost-Benefit Analysis; D005153:Facial Neoplasms / Q000191:economics* / Q000473:pathology / Q000601:surgery; D005260:Female; D006801:Humans; D015994:Incidence; D008297:Male; D015580:Mohs Surgery / Q000191:economics*; D009364:Neoplasm Recurrence, Local / Q000453:epidemiology; D009426:Netherlands; D011446:Prospective Studies; D011788:Quality of Life; D016896:Treatment Outcome