Direct Cost-Analysis of Mohs Micrographic Surgery and Traditional Excision for Basal Cell Carcinoma at Initial Margin Clearance

BACKGROUND The literature provides mixed results regarding cost comparisons of Mohs micrographic surgery (MMS) and traditional excision (TE). OBJECTIVE To complete a prospective cohort study comparing true costs of MMS with projected costs of TE for head and neck basal cell carcinoma (BCC). METHODS Patients referred for MMS of biopsy-proven BCC were eligible for inclusion. For each case, surgery with TE was planned before the patient proceeded to MMS. The true costs of MMS were compared with projected costs of TE. All TE patients with inadequate excision were assumed to have subsequent TE, and the cost of the subsequent procedure was assumed to be equal to the first. RESULTS The mean cost of MMS was $628.47 (95% CI: $617.73-$639.21) compared with $587.51 (95% CI: $558.42-$616.59) for TE. This difference of $40.96 to initial margin clearance was significant (z = 4.48, p < .001). CONCLUSION On average, MMS was found to be $40.96 more expensive than TE in treating BCC-a small but appreciable difference. This being the case, any fiscal comparison must also be tempered with a consideration of effectiveness. Accordingly, further work in the form of a cost-utility study is required to truly define the cost-effectiveness of MMS compared with TE in this setting.