B. Choy , R.L. Morton , D.F. Sebaratnam , R. Paver , P. Fernández Peñas
To determine the cost-effectiveness of Mohs micrographic
surgery (MMS) compared with traditional excision (TE) for
head and neck basal cell carcinoma (BCC), a modelled
cost-utility analysis was performed from the perspective of
the Australian healthcare system. The gold standard in economic
evaluations is to present cost per quality adjusted life
year (QALY) and this outcome was accordingly sought. A
Markov model simulating the natural history of BCC was
constructed and populated with the likely outcomes for
primary BCC treated with MMS or TE. Recurrence rates
were identified from published Skin and Cancer Foundation
Australia data. Where required data were not available, a
systematic review was performed and best available figures
utilised. A 5 year recurrence rate of 1% for primary BCC and
4% for recurrent BCC was employed for MMS and 5% for
primary BCC and 17% for recurrent BCC employed for TE.
Literature review was performed to determine a QALYweighting
associated with BCC recurrence of 0.98. Costs
were obtained in a separate study comparing true costs of
MMS with projected costs of TE yielding a mean MMS cost
of AUD$882 and mean TE cost of AUD$515. The mean
cumulative cost of MMS was AUD$1185 while the mean
cumulative cost of TE was AUD$1105: a difference of
AUD$80 over five years. Further work is being completed by
our group to better define the difference in QALYs between
interventions. At this stage, MMS is a much more financially
viable intervention for head and neck BCC compared to TE
than previously appreciated.