title: Fee comparisons of treatments for nonmelanoma skin cancer in a private practice academic setting.
abstract: OBJECTIVE
  To compare fees for biopsy, treatment procedure, repair, and 2-month follow-up for nonmelanoma skin cancer (NMSC) treatments: electrodesiccation and curettage (ED&C), excision, and Mohs micrographic surgery (MMS).
  
  
  METHODS
  A cost comparison of 936 primary NMSCs diagnosed in 1999/2000 at a University affiliated dermatology practice. Clinical data was from medical record review. 2007 Medicare Fee Schedule costs determined fees for surgical care. Pearson chi-square tests, t-tests and analysis of variance compared fee differences. Linear regression determined independent effects of tumor and treatment characteristics on fees.
  
  
  RESULTS
  Mean fees/lesion were $463 for ED&C, $1,222 for excision, and $2,085 for MMS (p < .001). For all treatments, primary procedure costs were highest (38%, 45%, and 41%). Total repair fees were higher with MMS ($735) vs excisions ($197). Fees were higher for head and neck tumors (p < .001), H-zone tumors (p < .001), and tumors smaller than 10 mm in diameter (p = .04). Regression models predicted that the treatment fees would be $2,109 for MMS and $1,252 for excision (p < .001). Tumor size greater than 10 mm in diameter (added $128), tumors on the head and neck (added $966), and MMS (added $857 vs excision) were independently related to higher fees (p < .001).
  
  
  CONCLUSIONS
  Even after adjusting for risk factors, MMS has higher fees than excision for primary NMSC. Repairs accounted for the majority of this difference. These fee comparisons provide a basis for comparative effectiveness studies of treatments for this common cancer.
authors.affiliation: University of California at San Francisco, San Francisco, California 94013, USA. wilsonl@pharmacy.ucsf.edu
authors.forename: Leslie S
authors.initials: LS
authors.lastname: Wilson
authors.forename: Mark
authors.initials: M
authors.lastname: Pregenzer
authors.forename: Rituparna
authors.initials: R
authors.lastname: Basu
authors.forename: Daniel
authors.initials: D
authors.lastname: Bertenthal
authors.forename: Jeanette
authors.initials: J
authors.lastname: Torres
authors.forename: Maryam
authors.initials: M
authors.lastname: Asgari
authors.forename: Mary-Margaret
authors.initials: MM
authors.lastname: Chren
mesh_terms: D002280:Basal Cell Carcinoma / Q000191:economics* / Q000601:surgery*; D002294:Carcinoma, Squamous Cell / Q000191:economics* / Q000601:surgery*; D005249:Fees and Charges; D005260:Female; D006801:Humans; D008297:Male; D011331:Private Practice; D012878:Skin Neoplasms / Q000191:economics* / Q000601:surgery*