title: Mohs versus traditional surgical excision for facial and auricular nonmelanoma skin cancer: an analysis of cost-effectiveness.
abstract: OBJECTIVE
  To evaluate and compare Mohs micrographic surgery and traditional excision in terms of cost and outcomes.
  
  
  METHODS
  We developed a computer-simulation, probabilistic, decision model to perform a cost-effectiveness analysis, with each patient serving as his or her own control.
  
  
  METHODS
  University of Connecticut dermatology clinic, a tertiary care referral center.
  
  
  METHODS
  Input data were derived from results of a consecutive sample of 98 patients with nonmelanoma skin cancer on the face and ears, estimates in the literature on 5-year recurrence rates, and a query of healthy focus-group participants.
  
  
  METHODS
  We considered Mohs and traditional excision strategies.
  
  
  METHODS
  Outcomes were measured in quality-adjusted life years, cost, and cost-effectiveness.
  
  
  RESULTS
  The Mohs strategy was $292 less expensive than the traditional surgical strategy and was more effective by an incremental quality-adjusted life year of 0.056 (translating to approximately 3 weeks of optimal quality of life). Results were robust to subgroup and sensitivity analyses.
  
  
  CONCLUSIONS
  Mohs may be more cost-effective than traditional excision in eradicating nonmelanoma skin cancer. Further investigation of costs from various geographic payment localities and assessment of quality-of-life outcomes from a population-based sample are needed.
authors.affiliation: Department of Dermatology, Emory University School of Medicine, Atlanta, Georgia 30322, USA.
authors.forename: Anne M
authors.initials: AM
authors.lastname: Seidler
authors.forename: Tracy B
authors.initials: TB
authors.lastname: Bramlette
authors.forename: Carl V
authors.initials: CV
authors.lastname: Washington
authors.forename: Herb
authors.initials: H
authors.lastname: Szeto
authors.forename: Suephy C
authors.initials: SC
authors.lastname: Chen
mesh_terms: D000368:Aged; D003362:Cost-Benefit Analysis; D004428:Ear Neoplasms / Q000191:economics* / Q000601:surgery*; D005153:Facial Neoplasms / Q000191:economics* / Q000601:surgery*; D005260:Female; D006801:Humans; D008297:Male; D015580:Mohs Surgery / Q000191:economics*; D009010:Monte Carlo Method; D009364:Neoplasm Recurrence, Local; D019057:Quality-Adjusted Life Years; D012878:Skin Neoplasms / Q000191:economics* / Q000601:surgery*