LAUSR

BACKGROUND The efficacy of Mohs Micrographic Surgery (MMS) in treating cutaneous Squamous Cell Carcinoma (cSCC) has been demonstrated. The cost-effectiveness of MMS has rarely been studied to support the perceived higher cost. OBJECTIVE Perform a cost-effectiveness analysis (CEA) to determine if MMS is cost-effective over wide local excision (WLE) for BWH tumor stage T2a cSCC over a 5-year period. METHODS A Markov model with a 5-year time horizon was created using variables from published data. Costs (U.S. dollars) and quality-adjusted life years (QALY) were calculated. RESULTS MMS was $333.83 less expensive ($4,365.57 [95%CI $3,664.68-$6,901.66] versus $4,699.41 [95%CI $3,782.94-$10,019.31]) than WLE and gained 2.22 weeks of perfect health (3.776 QALY [95%CI 3.774-3.777] for MMS and 3.733 QALY [95%CI 3.728-3.777]) over 5 years. Incremental cost-effectiveness ratio was -$7,822.19 (95%CI -$74,029.25 to $5,275.33). MMS had a 99.9% probability of being more cost-effective than WLE. Annualized savings of choosing MMS over WLE would be 200 million dollars and over 25,000 QALY. MMS could cost 3.1x its current rate and remain cost-effective. LIMITATIONS Relied on data from external retrospective sources. CONCLUSION MMS is less costly and more effective than WLE and should be strongly considered for stage T2a cSCC given improvements in costs and QALY.