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A Cost Comparison Analysis

Tracy L. Bialy, MD, MPH; James Whalen, MD; Emir Veledar, PhD; Denis Lafreniere, MD; Jeffrey Spiro, MD; Timothy Chartier, MD; Suephy C. Chen, MD, MS

Arch Dermatol. 2004;140:736-742.

Objective  To compare the cost and margin adequacy of Mohs micrographic surgery (Mohs) and traditional surgical excision (TSE) for the treatment of facial and auricular nonmelanoma skin cancer (NMSC).

Design  Prospective cost analysis with each patient serving as his or her own control.

Setting  Study was performed from 1999 to 2001 at the University of Connecticut dermatology clinic, a tertiary care referral center.

Patients  A total of 98 consecutive patients with a primary diagnosis of NMSC on the face and ears.

Main Outcome Measures  The average cost of Mohs and TSE per patient for the treatment and repair of NMSC; adequacy of TSE margins after the initial procedure(because this outcome affects overall cost).

Results  Mohs was cost comparable to TSE when the subsequent procedure for inadequate TSE margins after permanent section was Mohs ($937 vs $1029; P = .16) or a subsequent TSE ($937 vs $944; P = .53). When facility-based frozen sections were requested for TSE, Mohs was significantly less costly ($956 vs $1399; P<.001). The cost difference between Mohs and TSE was sensitive to the type of repair chosen.

Conclusions  If the end point is clear margins, Mohs is cost comparable to TSE performed by otolaryngologic surgeons. Some caution is needed when evaluating the cost of facial and auricular NMSC treatment because the choice of repair can significantly affect the cost conclusions.

From the Departments of Dermatology (Drs Bialy and Chen) and Medicine, Division of Cardiology (Dr Veledar), Emory Center for Outcomes Research, Emory University School of Medicine, and the Department of Health Services Research and Development, Division of Dermatology, Atlanta Veterans Affairs Medical Center (Dr Chen), Atlanta, Ga; and the Departments of Dermatology (Drs Whalen and Chartier) and Otolaryngology (Drs Lafreniere and Spiro), University of Connecticut School of Medicine, Farmington. The authors have no relevant financial interest in this article.

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