Abstract Number: 15

Cost-effectiveness analysis of Mohs micrographic surgery versus traditional surgical excision for head and neck basal cell carcinoma in Australia

D. Sebaratnam , R. Paver P. Fernández Peñas

Meeting: 2012 Dermcoll

Session Information

Date: -

Session Title: Insights in Skin Cancer Management

Session Time: -

Background: Mohs micrographic surgery (MMS) is regarded as the intervention offering the lowest recurrence rates for basal cell carcinoma (BCC) management, however it is also comparatively costly. Previous cost-effectiveness analysis of MMS versus traditional surgical excision (TSE) calculated an incremental cost effectiveness ratio (ICER) of c 23,454/BCC recurrence avoided with MMS from a European hospital perspective, however signifi cant differences in recurrence rate were identifi ed in comparison to Australia data.
Objective: To perform a modelled cost-effectiveness analysis of MMS versus TSE for head and neck BCC from the perspective of the Australian healthcare system
Methods: A decision tree was constructed using TreeAge Pro 2011 software incorporating likely outcomes for primary BCC treated with MMS or TSE. Recurrence rates were identifi ed from data obtained from the Skin and Cancer Foundation. Where required data was not available, a systematic review was performed and best available data utilised. Costings were obtained from the Medicare Benefi ts Sched- ule November 2011. Sensitivity analysis was performed incorporating a range of values depending on BCC size and recurrence rate employed.
Results: A preliminary ICER of AUD$870–3392/recurrence avoided was calculated for MMS depending on size and recurrence rate utilised. This is appreciably lower than the ICER extant in the literature, with the discordance attributable to differences between Australian and European recurrence rates for both interventions. Conclusion: MMS is more fi nancially viable than previously appreciated in the management of head and neck BCC based on these preliminary fi ndings. Further analysis including micro-costing, societal costs and quality-of-life measurement is to be performed.