Actas Dermo-Sifiliográficas Actas Dermo-Sifiliográficas
Actas Dermosifiliogr.2010;101:622-8 - Vol. 101 Num.7 DOI: 10.1016/S1578-2190(10)70684-3
Original article
Cost Analysis of Mohs Micrographic Surgery in High-Risk Facial Basal Cell Carcinoma
Análisis de costes de la cirugía micrográfica de Mohs en el carcinoma basocelular facial de alto riesgo
N. Blázquez-Sáncheza,b,, , M. de Troya-Martína,b, M. Frieyro-Eliceguia, R. Fúnez-Liébanac, L. Martín-Márquezd, F. Rivas-Ruize
a Servicio de Dermatología, Empresa Pública Hospital Costa del Sol, Marbella, Málaga, Spain
b CIBER Epidemiología y Salud Pública (CIBERESP), Empresa Pública Hospital Costa del Sol, Marbella, Málaga, Spain
c Laboratorio de Anatomía Patológica, Empresa Pública Hospital Costa del Sol, Marbella, Málaga, Spain
d Departamento de Económico, Empresa Pública Hospital Costa del Sol, Marbella, Málaga, Spain
e Unidad de Investigación, Empresa Pública Hospital Costa del Sol, Marbella, Málaga, Spain
Received 14 November 2009, Accepted 17 February 2010
Abstract
Introduction

Mohs micrographic surgery (MMS) is the treatment of choice for high-risk facial basal cell carcinoma (BCC) as it offers the greatest chance of cure with maximum preservation of healthy tissue. Its use in Spanish public health care hospitals is still limited, however, due to the controversy surrounding its cost.

Objectives

To determine the cost of MMS with fresh tissue to treat high-risk facial BCC and compare this to the estimated cost of conventional surgery in a Spanish public hospital. A secondary objective was to identify cost-optimization strategies for MMS.

Material and methods

Cross-sectional study of a consecutive series of patients with high-risk facial BCC who underwent MMS at the Department of Dermatology at Hospital Costa del Sol in Malaga, Spain between July 2006 and December 2007. We performed a descriptive analysis of the clinical characteristics of the patients and surgical factors. We calculated the total and mean cost of MMS and compared the results to the estimated costs of conventional surgery using patients as their own controls. Differences were analyzed according to tumor site and size, histologic subtype, and recurrence.

Results

Seventy-nine patients (mean age, 62 years) with 81 high-risk facial BCCs, 97.5% of which were primary tumors, underwent MMS. The most common tumor site was the nose (57%) followed by the orbital region (25%). Histology showed that 64% of the tumors were infiltrative or micronodular carcinomas. Tumor-free margins were achieved in all patients, with no more than 2 stages required in 88% of the cases. The most common surgical reconstruction techniques were direct closure (21%) and closure with a local skin flap or graft (71%); the corresponding estimates for conventional surgery were 2% and 89%, respectively. The total and mean cost of MMS was €106 129.07 and €1325.80, respectively (compared to €97700 and €1208.70 for conventional surgery). The difference in mean costs between MMS and conventional surgery was not significant (P=.534).

Conclusions

MMS is a viable, effective technique that does not generate significantly higher costs than conventional surgery in selected patients with high-risk facial BCC. Certain technical and organizational strategies could contribute to optimizing the cost of MMS.

Resumen
Introducción

La cirugía micrográfica de Mohs constituye el tratamiento de elección del carcinoma basocelular de alto riesgo, pues ofrece la mayor garantía de curación con la máxima preservación de tejido sano. Sin embargo, su implementación en hospitales del ámbito sanitario público españoles es minoritaria hasta la fecha, debido a que el coste económico de esta técnica continúa siendo motivo de controversia.

Objetivo

Determinar los costes de la cirugía micrográfica de Mohs en fresco (CMF) en el tratamiento del carcinoma basocelular facial de alto riesgo (CBFR) frente al coste teórico mediante cirugía convencional (CC), en un centro hospitalario del ámbito sanitario público español. Identificar estrategias de optimización de costes en este tipo de cirugía.

Material y métodos

Estudio transversal de una serie consecutiva de pacientes con CBFR intervenidos mediante CMF en el Servicio de Dermatología del Hospital Costa del Sol desde julio 2006 a diciembre 2007. Se realizó un análisis descriptivo de las características clínicas de la serie y aspectos quirúrgicos. Se realizó un estudio de costes (coste total y coste medio) de la CMF y se compararon con los costes teóricos de la CC, utilizando cada paciente como su propio control. Se analizaron las diferencias por localización, tamaño del tumor, histología y recurrencia.

Resultados

Se intervinieron con CMF 79 pacientes con 81 CBFR (edad media = 62 años). El 97,5% fueron tumores primarios. La localización más frecuente fue la pirámide nasal (57%) seguida de la región orbitaria (25%). El 64% correspondieron a tipos histológicos infiltrativo y micronodular. La exéresis tumoral mediante CMF se concluyó en todos los casos con márgenes libres, requiriéndose en el 88% únicamente uno o dos estadios. Las técnicas de reconstrucción quirúrgica más empleadas fueron el cierre directo y colgajo local (21 y 71% de los casos respectivamente en la CMF, frente al 2 y 89% en la CC). El coste total y coste medio de la CMF fue de 106.129,07 y 1.325,8 euros respectivamente (frente a 97.770 y 1.208,7 euros de la CC). La diferencia de costes entre ambos procedimientos no fue significativa (p = 0,534).

Conclusiones

LA CMF es una técnica factible, eficaz y que genera costes que no son significativamente superiores a los de la CC en pacientes seleccionados con CBFR. Algunas estrategias técnicas y organizativas pueden contribuir a la optimización de costes de esta cirugía.

Palabras clave
Cirugía micrográfica, Mohs, Análisis de costes, Coste/beneficio
Keywords
Micrographic surgery, Mohs, Cost analysis, Cost-effectiveness
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Corresponding author.
Copyright © 2010. Academia Española de Dermatología y Venereología and Elsevier España, S.L.
Actas Dermosifiliogr.2010;101:622-8 - Vol. 101 Num.7 DOI: 10.1016/S1578-2190(10)70684-3