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Brigitte A. B. Essers, MHSc; Carmen D. Dirksen, PhD; Fred H. M. Nieman, PhD; Nicole W. J. Smeets, MD; Gertrude A. M. Krekels, MD, PhD; Martin H. Prins, MD, PhD; H. A. Martino Neumann, MD, PhD

Arch Dermatol. 2006;142:187-194.

Objective  To assess the cost-effectiveness of Mohs micrographic surgery (MMS) compared with the surgical excision for both primary and recurrent basal cell carcinoma (BCC).

Design  A cost-effectiveness study performed alongside a prospective randomized clinical trial in which MMS was compared with surgical excision.

Setting  The study was carried out from 1999 to 2002 at the dermatology outpatient clinic of the University Hospital Maastricht, Maastricht, the Netherlands.

Participants  A total of 408 primary (374 patients) and 204 recurrent (191 patients) cases of facial BCC were included.

Main Outcome Measures  The mean total treatment costs of MMS and surgical excision for both primary and recurrent BCC and the incremental cost-effectiveness ratio, calculated as the difference in costs between MMS and surgical excision divided by their difference in effectiveness. The resulting ratio is defined as the incremental costs of MMS compared with surgical excision to prevent 1 additional recurrence.

Results  Compared with surgical excision, the total treatment costs of MMS are significantly higher (cost difference: primary BCC, 254; 95% confidence interval, 181-324; recurrent BCC, 249; 95% confidence interval, 175-323). For primary BCC, the incremental cost-effectiveness ratio was 29 231, while the ratio for recurrent BCC amounted to 8094. The acceptability curves showed that for these ratios, the probability of MMS being more cost-effective than surgical excision never reached 50%.

Conclusions  At present, it does not seem cost-effective to introduce MMS on a large scale for both primary and recurrent BCC. However, because a 5-year period is normally required to determine definite recurrence rates, it is possible that MMS may become a cost-effective treatment for recurrent BCC.

Author Affiliations: Departments of Clinical Epidemiology and Medical Technology Assessment (Ms Essers and Drs Dirksen, Nieman, and Prins) and Dermatology (Dr Smeets), University Hospital Maastricht, Maastricht; Catharina Hospital, Eindhoven (Dr Krekels); and Erasmus MC, Rotterdam (Dr Neumann), the Netherlands.

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