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Monday, 18 October 2004

This presentation is part of: Poster Session - CEA: Methods and Applications; Health Services Research

IS MOHS SURGERY A COST-EFFECTIVE TREATMENT FOR FACIAL NONMELANOMA SKIN CANCER? A DECISION ANALYSIS

Tracy L. Bialy, M.D., MPH1, Carl V. Washington, M.D1, Herb Szeto, M.D2, James Whalen, M.D3, and Suephy C Chen, MD, MS4. (1) Emory University School of Medicine, Dermatology, Atlanta, GA, (2) Kaiser Permanente, Medicine, Redwood City, CA, (3) University of Connecticut, Dermatology, Farmington, CT, (4) Emory University, Department of Dermatology, Atlanta, GA

Purpose: Nonmelanoma skin cancers (NMSC), including basal cell carcinoma (BCC) and squamous cell carcinoma (SCC), are the most common cancers in the United States, accounting for more than 1,000,000 new cases per year. More than 65% of all BCCs and SCCs affect facial sites with both cosmetic and functional sequela. Two common treatment modalities for NMSC are Mohs Surgery (Mohs) and traditional surgical excision (TSE), each with a different efficacy and cost. The purpose of this study was to determine whether Mohs is a more cost-effective method of treatment for facial NMSC than TSE.

Methods: The data from our prospective trial of 98 consecutive patients with primary facial NMSC was used to obtain baseline cost (Connecticut Medicare 2002 reimbursements) and efficacy (margin analysis) information for our CEA. We approached the CEA using a decision analysis model via Treeage Data 4.0 software. Our model also incorporated efficacy using 5-year recurrence rates from the literature, and outcomes (quality-adjusted-life-years (QALY)) using data from a focus group of patients. We performed a sensitivity analysis to determine the influence of key estimates in the model.

Results: Our baseline CEA demonstrated Mohs to be less costly and more effective than TSE ($956.60 vs. $1248.10, and 0.6 QALY gain). The sensitivity analysis showed that varying values for QALYs, recurrence rates, and percentage of frozen and permanent section margin analysis did not change the results of our CEA. However, our results were sensitive to varying the proportion/cost of defect repairs (granulation, primary closure, flaps, grafts) following the two procedure strategies.

Conclusions: Therefore, before the most cost-effective treatment for facial NMSC can be definitively established, further research into actual practice patterns of defect repair selection for both procedures must be examined.


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