Xinyuan Wu1, Elena B Elkin2, Chih-Shan Jason Chen1, Ashfaq Marghoob3. 1. Dermatology Service, Memorial Sloan Kettering Cancer Center, Hauppauge, New York. 2. Center for Health Policy and Outcomes, Department of Epidemiology and Biostatistics, Memorial Sloan Kettering Cancer Center, New York, New York. 3. Dermatology Service, Memorial Sloan Kettering Cancer Center, Hauppauge, New York. Electronic address: marghooa@mskcc.org.
Abstract
BACKGROUND: Facing rising incidence of basal cell carcinoma (BCC) and increasing pressure to contain health care spending, physicians need to contemplate cost-effective paradigms for managing BCC. OBJECTIVE: We sought to perform a cost analysis comparing the traditional BCC management scheme with a simplified detect-and-treat scheme that eliminates the biopsy before initiating definitive treatment. METHODS: A decision analytic model was developed to compare the costs of traditional BCC management with the detect-and-treat scheme, under which qualifying lesions diagnosed clinically were either treated with shave removal or referred to Mohs micrographic surgery for on-site histologic check. Values for model parameters were based on literature and our institutional data analysis. Costs were based on 2014 Medicare fee schedule. RESULTS: The average cost per lesion with detect-and-treat scheme was $449 for non-Mohs micrographic surgery-indicated lesions (vs $566 with traditional management, $117 in savings) and $819 for Mohs micrographic surgery-indicated lesions (vs $864 with traditional management, $45 in savings). The combined weighted average savings per case was $95 (15% of total average cost). Conclusions were similar under various plausible scenarios. LIMITATIONS: Model parameter values may vary based on individual practices. CONCLUSIONS: A simplified management strategy eliminating routine pretreatment biopsy can reduce BCC treatment cost without compromising quality of care.
BACKGROUND: Facing rising incidence of basal cell carcinoma (BCC) and increasing pressure to contain health care spending, physicians need to contemplate cost-effective paradigms for managing BCC. OBJECTIVE: We sought to perform a cost analysis comparing the traditional BCC management scheme with a simplified detect-and-treat scheme that eliminates the biopsy before initiating definitive treatment. METHODS: A decision analytic model was developed to compare the costs of traditional BCC management with the detect-and-treat scheme, under which qualifying lesions diagnosed clinically were either treated with shave removal or referred to Mohs micrographic surgery for on-site histologic check. Values for model parameters were based on literature and our institutional data analysis. Costs were based on 2014 Medicare fee schedule. RESULTS: The average cost per lesion with detect-and-treat scheme was $449 for non-Mohs micrographic surgery-indicated lesions (vs $566 with traditional management, $117 in savings) and $819 for Mohs micrographic surgery-indicated lesions (vs $864 with traditional management, $45 in savings). The combined weighted average savings per case was $95 (15% of total average cost). Conclusions were similar under various plausible scenarios. LIMITATIONS: Model parameter values may vary based on individual practices. CONCLUSIONS: A simplified management strategy eliminating routine pretreatment biopsy can reduce BCC treatment cost without compromising quality of care.
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