基底细胞癌（BCC）的传统管理与简化管理：成本分析。

Traditional versus streamlined management of basal cell carcinoma (BCC): A cost analysis.

作者信息

Wu Xinyuan, Elkin Elena B, Jason Chen Chih-Shan, Marghoob Ashfaq

机构信息

Dermatology Service, Memorial Sloan Kettering Cancer Center, Hauppauge, New York.

Center for Health Policy and Outcomes, Department of Epidemiology and Biostatistics, Memorial Sloan Kettering Cancer Center, New York, New York.

出版信息

J Am Acad Dermatol. 2015 Nov;73(5):791-8. doi: 10.1016/j.jaad.2015.07.021. Epub 2015 Sep 2.

DOI:10.1016/j.jaad.2015.07.021

PMID:26341142

原文链接:https://pmc.ncbi.nlm.nih.gov/articles/PMC5031151/

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.

摘要

背景

面对基底细胞癌（BCC）发病率的上升以及控制医疗保健支出的压力不断增大，医生需要考虑管理BCC的具有成本效益的模式。

目的

我们试图进行一项成本分析，将传统的BCC管理方案与一种简化的检测与治疗方案进行比较，该简化方案在开始确定性治疗前省去活检步骤。

方法

开发了一个决策分析模型，以比较传统BCC管理方案与检测与治疗方案的成本，在检测与治疗方案中，临床诊断的符合条件的病变要么通过刮除术治疗，要么转诊至莫氏显微外科手术进行现场组织学检查。模型参数值基于文献和我们机构数据分析。成本基于2014年医疗保险费用表。

结果

对于非莫氏显微外科手术指征的病变，检测与治疗方案下每个病变的平均成本为449美元（传统管理方案为566美元，节省117美元）；对于莫氏显微外科手术指征的病变，平均成本为819美元（传统管理方案为864美元，节省45美元）。每例病例的综合加权平均节省成本为95美元（占总平均成本的15%）。在各种合理情况下得出的结论相似。