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

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 surgeryeindicated lesions (vs $566 with traditional management, $117 in savings) and $819 for Mohs micrographic surgeryeindicated 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.