Direct Cost-Analysis of Mohs Micrographic Surgery and Traditional Excision for Basal Cell Carcinoma at Initial Margin Clearance.
BACKGROUND
The literature provides mixed results regarding cost comparisons of Mohs micrographic surgery (MMS) and traditional excision (TE).


OBJECTIVE
To complete a prospective cohort study comparing true costs of MMS with projected costs of TE for head and neck basal cell carcinoma (BCC).


METHODS
Patients referred for MMS of biopsy-proven BCC were eligible for inclusion. For each case, surgery with TE was planned before the patient proceeded to MMS. The true costs of MMS were compared with projected costs of TE. All TE patients with inadequate excision were assumed to have subsequent TE, and the cost of the subsequent procedure was assumed to be equal to the first.


RESULTS
The mean cost of MMS was $628.47 (95% CI: $617.73-$639.21) compared with $587.51 (95% CI: $558.42-$616.59) for TE. This difference of $40.96 to initial margin clearance was significant (z = 4.48, p < .001).


CONCLUSIONS
On average, MMS was found to be $40.96 more expensive than TE in treating BCC-a small but appreciable difference. This being the case, any fiscal comparison must also be tempered with a consideration of effectiveness. Accordingly, further work in the form of a cost-utility study is required to truly define the cost-effectiveness of MMS compared with TE in this setting.
*Department of Dermatology, Westmead Hospital, Westmead, Australia; †Skin and Cancer Foundation Australia, Westmead, Australia; ‡Western Clinical School, University of Sydney, Westmead, Australia.
Deshan F
DF
Sebaratnam
Bonita
B
Choy
Michael
M
Lee
Robert
R
Paver
Pablo
P
Fernández Peñas
D002280:Basal Cell Carcinoma / Q000601:surgery*; D003362:Cost-Benefit Analysis; D003365:Costs and Cost Analysis; D005260:Female; D006801:Humans; D008297:Male; D008875:Middle Aged; D015580:Mohs Surgery / Q000191:economics*; D011446:Prospective Studies; D012878:Skin Neoplasms / Q000601:surgery*