Essers Brigitte A B, Dirksen Carmen D, Nieman Fred H M, Smeets Nicole W J, Krekels Gertrude A M, Prins Martin H, Neumann H A Martino
Department of Clinical Epidemiology and Medical Technology Assessment, University Hospital Maastricht, The Netherlands.
Arch Dermatol. 2006 Feb;142(2):187-94. doi: 10.1001/archderm.142.2.187.
To assess the cost-effectiveness of Mohs micrographic surgery (MMS) compared with the surgical excision for both primary and recurrent basal cell carcinoma (BCC).
A cost-effectiveness study performed alongside a prospective randomized clinical trial in which MMS was compared with surgical excision.
The study was carried out from 1999 to 2002 at the dermatology outpatient clinic of the University Hospital Maastricht, Maastricht, The Netherlands.
A total of 408 primary (374 patients) and 204 recurrent (191 patients) cases of facial BCC were included.
The mean total treatment costs of MMS and surgical excision for both primary and recurrent BCC and the incremental cost-effectiveness ratio, calculated as the difference in costs between MMS and surgical excision divided by their difference in effectiveness. The resulting ratio is defined as the incremental costs of MMS compared with surgical excision to prevent 1 additional recurrence.
Compared with surgical excision, the total treatment costs of MMS are significantly higher (cost difference: primary BCC, 254 euros; 95% confidence interval, 181-324 euros; recurrent BCC, 249 euros; 95% confidence interval, 175-323 euros). For primary BCC, the incremental cost-effectiveness ratio was 29,231 euros, while the ratio for recurrent BCC amounted to 8094 euros. The acceptability curves showed that for these ratios, the probability of MMS being more cost-effective than surgical excision never reached 50%.
At present, it does not seem cost-effective to introduce MMS on a large scale for both primary and recurrent BCC. However, because a 5-year period is normally required to determine definite recurrence rates, it is possible that MMS may become a cost-effective treatment for recurrent BCC.
评估莫氏显微描记手术（MMS）与手术切除治疗原发性和复发性基底细胞癌（BCC）的成本效益。
一项成本效益研究，同时进行一项前瞻性随机临床试验，将MMS与手术切除进行比较。
该研究于1999年至2002年在荷兰马斯特里赫特大学医院皮肤科门诊进行。
共纳入408例原发性（374例患者）和204例复发性（191例患者）面部BCC病例。
MMS和手术切除治疗原发性和复发性BCC的平均总治疗成本，以及增量成本效益比，计算方法为MMS与手术切除的成本差异除以其效果差异。所得比率定义为MMS与手术切除相比预防1例额外复发的增量成本。
与手术切除相比，MMS的总治疗成本显著更高（成本差异：原发性BCC为254欧元；95%置信区间为181 - 324欧元；复发性BCC为249欧元；95%置信区间为175 - 323欧元）。对于原发性BCC，增量成本效益比为29,231欧元，而复发性BCC的比率为8094欧元。可接受性曲线显示，对于这些比率，MMS比手术切除更具成本效益的概率从未达到50%。
目前，大规模引入MMS治疗原发性和复发性BCC似乎不具有成本效益。然而，由于通常需要5年时间来确定确切的复发率，MMS有可能成为治疗复发性BCC的一种具有成本效益的治疗方法。
