Cost-effectiveness of surgical excision versus Mohs micrographic surgery for nonmelanoma skin cancer: A retrospective cohort study

Abstract

Background: Nonmelanoma skin cancer rates are increasing worldwide. Mohs micrographic surgery and surgical excision (SE) are the two treatment methods for this type of cancer. The current paper aims at determining and comparing the  cost-effectiveness of SE and Mohs micrographic surgery. Materials and Methods: The current study has a retrospective cohort design. A number of 630 patients suffering from nonmelanoma skin cancer who at some point of time during the years 2007–2014 referred to the Al-Zahra or Seyed Al-Shohada Hospitals in Isfahan. Patients were followed up for 4 years, and then the incremental cost-effectiveness ratio (ICER) of the two methods was calculated. Results: The average (minimum-maximum) cost of the SE and Mohs surgery methods in Iran was obtained as 18,550,170 (2335,800–260,898,262) and 12,236,890 (6488,340–41,161,700) Iranian Rials, respectively. Recurrence percentage was also reported as 7.9% and 8.7% for SE and Mohs micrographic surgery, respectively (P > 0.05). The ICER of SE in comparison with Mohs surgery was calculated as 7891,600 Iranian Rials per recurrence avoided. Conclusions: Mohs surgery is less expensive than SE, it seems like Mohs surgery is more affordable, however further studies in different populations of the country are needed.

Key words: Cost-effectiveness, Mohs micrographic surgery, nonmelanoma skin cancer, surgical excision