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Eliminating pretreatment biopsy reduced cost without compromising care for BCC
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A simplified detect-and-treat scheme that eliminates the biopsy before initiating treatment of basal cell carcinoma resulted in cost savings while maintaining quality of care, according to recently published study results.
Researchers developed a decision analytic model to compare costs of traditional basal cell carcinoma (BCC) management, which involved pretreatment biopsy in all cases, and a detect-and-treat scheme, in which patients presenting with well-delineated and unequivocal BCC lesions were offered shave removal or referred to a Mohs micrographic surgeon, who conducted an on-site histologic check. Literature and institutional data analysis were used to determine values for model parameters, and a 2014 Medicare fee schedule was used to estimate costs.
There were 137 patients (average age, 66 years; 91 men) with 204 lesions that received shave removal. Clear margins on pathology was used to define successful removal on initial attempt in 86% of lesions.
Using the detect-and-treat scheme, the average cost per lesion was $449 for non-Mohs micrographic surgery (MMS)-indicated lesions compared with $566 for traditional management of the lesion, for a 21% savings. The average cost per lesion for the detect-and-treat scheme for MMS-indicated lesions was $819, compared with $864 for traditional treatment, for a 5% savings. The weighted average of expected savings per case was $95 or 15% total costs, under the assumption that 30% of BCCs are treated by MMS.
“Our results suggest that the [detect-and-treat] scheme is less costly under a wide range of parameter values derived from literature and our own clinical experience,” the researchers wrote.
“Our institutional data suggest that the [detect-and-treat] strategy is associated with complication and recurrence rates comparable with those reported with traditionally managed BCCs.”
“Ultimately, the decision of the optimal treatment of BCC is between the patient and their physician, but we believe the [detect-and-treat] scheme is both an economically beneficial and patient-convenient alternative to the traditional approach for treatment of BCCs,” the researchers concluded. – By Bruce Thiel
Disclosure: The researchers report no relevant financial disclosures.
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