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Mohs Versus Traditional Surgical Excision for Facial and Auricular Nonmelanoma Skin Cancer: An Analysis of Cost‐Effectiveness

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. The authors have indicated no significant interest with commercial supporters.