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The Cost of Mohs Surgery vs. Excision

This cost-effectiveness analysis might benefit from a longer follow-up period.

Mohs micrographic surgery (MMS) is often used to treat tumors at high risk for recurrence. Are the greater medical resources required by Mohs surgery justified by the higher cure rate? In this study from the Netherlands, the authors report the results of a cost-effectiveness analysis that was performed concurrently with a previously reported treatment-comparison study (see JW Dermatol Dec 14 2004). In this analysis, the authors compare the cost of needed resources for 408 primary facial basal cell carcinomas (BCCs) and 204 recurrent facial BCCs treated by MMS or in-office excision.

The mean cost (not charges) for MMS, including the cost of repair, was $1007 for a primary BCC and $994 for a recurrent BCC. The cost of excision was $771 for a primary BCC and $745 for a recurrent BCC. The differences were statistically significant. For primary tumors, the recurrence rate at 30 months was 1.5% after MMS and 2.5% after excision. For recurrent tumors, recurrence rates were 0% after MMS and 3% after excision. The authors projected the added cost of using MMS to prevent one future recurrence to be $26,016 for a primary facial BCC and $7204 for a recurrent BCC.

Comment: These findings show higher resource costs for MMS than for in-office excision. However, the added costs are exaggerated by a short follow-up period that underestimates the true rate of recurrence. This is especially true for the excised tumors, which are known to have higher recurrence rates. The unexpectedly high rate of MMS recurrence seen in this study is at least double that reported after MMS removal of primary BCCs in other, much larger patient series. If the cost analysis were recalculated, using the combined 5-year recurrence rates after MMS (1.0% primary, 5.6% recurrent) and excisional surgery (10.1% primary, 17.4% recurrent) reported in prior studies, the added costs of preventing recurrence would be much more reasonable — $2593 for a primary BCC and $2110 for a recurrent BCC.

— George J. Hruza, MD

Published in Journal Watch Dermatology March 28, 2006

Citation(s):

Essers BA et al. Cost-effectiveness of Mohs micrographic surgery vs surgical excision for basal cell carcinoma of the face. Arch Dermatol 2006 Feb; 142:187-94.

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