Mohs versus traditional surgical excision for facial and auricular nonmelanoma skin cancer: an analysis of cost-effectiveness.

Autor: Seidler AM; Department of Dermatology, Emory University School of Medicine, Atlanta, Georgia 30322, USA., Bramlette TB, Washington CV, Szeto H, Chen SC
Jazyk: angličtina
Zdroj: Dermatologic surgery : official publication for American Society for Dermatologic Surgery [et al.] [Dermatol Surg] 2009 Nov; Vol. 35 (11), pp. 1776-87. Date of Electronic Publication: 2009 Sep 08.
DOI: 10.1111/j.1524-4725.2009.01291.x
Abstrakt: Objective: To evaluate and compare Mohs micrographic surgery and traditional excision in terms of cost and outcomes.
Design: We developed a computer-simulation, probabilistic, decision model to perform a cost-effectiveness analysis, with each patient serving as his or her own control.
Setting: University of Connecticut dermatology clinic, a tertiary care referral center.
Participants: 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.
Intervention: We considered Mohs and traditional excision strategies.
Main Outcome Measures: 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.
Databáze: MEDLINE
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