Mohs versus traditional surgical excision for facial and auricular nonmelanoma skin cancer: an analysis of cost-effectiveness.
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.
Seidler
Anne M
AM
Department of Dermatology, Emory University School of Medicine, Atlanta, Georgia 30322, USA.
Bramlette
Tracy B
TB
Washington
Carl V
CV
Szeto
Herb
H
Chen
Suephy C
SC
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*