Current issues & opinionA relative value unit–based cost comparison of treatment modalities for nonmelanoma skin cancer: Effect of the loss of the Mohs multiple surgery reduction exemption
Section snippets
Methods
In order to estimate and compare the costs to the health care system of treating NMSC, two typical skin cancer cases (a basal cell carcinoma [BCC] of the central cheek and a squamous cell carcinoma [SCC] on the forearm) of varying sizes were selected for evaluation. The tumor sizes selected for analysis are 0.6, 1.1, 2.1, and 3.1 cm. Insurance-based reimbursement of medical procedures is dependent on the relative value units (RVU) values assigned to the individual medical, surgical, and/or
Results
Our cost analysis of NMSC treatments reveals that EDC is the least expensive treatment modality examined (Table I, Table II). The average cost for EDC is $471 (BCC cheek) and $392 (SCC arm). Imiquimod and office-based excision with permanent sections and immediate repair have approximately equal average costs of $959 (BCC cheek) and $931 (SCC arm) versus $1006 (BCC cheek) and $907 (SCC arm), respectively. At smaller lesion sizes, excision is less expensive than imiquimod, with 0.6-cm lesion
Discussion
This study evaluates the cost to treat two skin cancer examples of varied initial clinical size and location with different therapeutic modalities and clinical settings. EDC is the least expensive treatment option at all tumor sizes examined, with costs about 64% lower than Mohs surgery and 55% lower than office-based excision. Imiquimod therapy has average total costs approximately equal to office-based excision but is more expensive than excision at smaller lesion sizes. Mohs surgery is about
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2019, Journal of the American Academy of DermatologyCitation Excerpt :Cost varies greatly based on the chosen treatment modality. A study that calculated the average cost of treatment for a standard lesion (BCC on cheek, averaged across the 4 lesion size reimbursement ranges) using the 2008 Resource-Based Relative Value Scale, which included costs of obtaining the biopsy specimen, pathology, repair, and follow-up, found that radiation ($2591-3460) was the most expensive treatment, followed by Mohs micrographic surgery ($1263), standard excision ($1006-1170), topical imiquimod ($959), and electrodessication/curettage ($471).43,44 Vismodegib was not included in this analysis.
Mohs Micrographic Surgery
2019, Facial Plastic Surgery Clinics of North AmericaCitation Excerpt :The Mohs AUC does not explicitly integrate cost into the appropriateness ratings; however, cost was considered secondary to the degree of potential clinical improvement.83 MMS is cost-effective in the treatment of nonmelanoma skin cancer (NMSC).89–93 With the Mohs surgeon serving as both surgeon and pathologist, the MMS billing codes include all of the following: entire surgical procedure, anesthesia, pathology processing and evaluation, and cost of supplies.17
An ecological study of skin biopsies and skin cancer treatment procedures in the United States Medicare population, 2000 to 2015
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Funding sources: None.
Conflicts of interest: None declared.