The authors have indicated no significant interest with commercial supporters.
Fee Comparisons of Treatments for Nonmelanoma Skin Cancer in a Private Practice Academic Setting
Article first published online: 6 DEC 2011
© 2011 by the American Society for Dermatologic Surgery, Inc. Published by Wiley Periodicals, Inc.
Volume 38, Issue 4, pages 570–584, April 2012
How to Cite
Wilson, L. S., Pregenzer, M., Basu, R., Bertenthal, D., Torres, J., Asgari, M. and Chren, M.-M. (2012), Fee Comparisons of Treatments for Nonmelanoma Skin Cancer in a Private Practice Academic Setting. Dermatologic Surgery, 38: 570–584. doi: 10.1111/j.1524-4725.2011.02231.x
- Issue published online: 29 MAR 2012
- Article first published online: 6 DEC 2011
To compare fees for biopsy, treatment procedure, repair, and 2-month follow-up for nonmelanoma skin cancer (NMSC) treatments: electrodesiccation and curettage (ED&C), excision, and Mohs micrographic surgery (MMS).
A cost comparison of 936 primary NMSCs diagnosed in 1999/2000 at a University affiliated dermatology practice. Clinical data was from medical record review. 2007 Medicare Fee Schedule costs determined fees for surgical care. Pearson chi-square tests, t-tests and analysis of variance compared fee differences. Linear regression determined independent effects of tumor and treatment characteristics on fees.
Mean fees/lesion were $463 for ED&C, $1,222 for excision, and $2,085 for MMS (p < .001). For all treatments, primary procedure costs were highest (38%, 45%, and 41%). Total repair fees were higher with MMS ($735) vs excisions ($197). Fees were higher for head and neck tumors (p < .001), H-zone tumors (p < .001), and tumors smaller than 10 mm in diameter (p = .04). Regression models predicted that the treatment fees would be $2,109 for MMS and $1,252 for excision (p < .001). Tumor size greater than 10 mm in diameter (added $128), tumors on the head and neck (added $966), and MMS (added $857 vs excision) were independently related to higher fees (p < .001).
Even after adjusting for risk factors, MMS has higher fees than excision for primary NMSC. Repairs accounted for the majority of this difference. These fee comparisons provide a basis for comparative effectiveness studies of treatments for this common cancer.