Original article
Cost Analysis of Mohs Micrographic Surgery in High-Risk Facial Basal Cell Carcinoma
Análisis de costes de la cirugía micrográfica de Mohs en el carcinoma basocelular facial de alto riesgo
N. Blázquez-Sáncheza,b,
, M. de Troya-Martína,b, M. Frieyro-Eliceguia, R. Fúnez-Liébanac, L. Martín-Márquezd, F. Rivas-Ruize
Autor para correspondencia
a Servicio de Dermatología, Empresa Pública Hospital Costa del Sol, Marbella, Málaga, Spain
b CIBER Epidemiología y Salud Pública (CIBERESP), Empresa Pública Hospital Costa del Sol, Marbella, Málaga, Spain
c Laboratorio de Anatomía Patológica, Empresa Pública Hospital Costa del Sol, Marbella, Málaga, Spain
d Departamento de Económico, Empresa Pública Hospital Costa del Sol, Marbella, Málaga, Spain
e Unidad de Investigación, Empresa Pública Hospital Costa del Sol, Marbella, Málaga, Spain
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"apellidos" => "Blázquez-Sánchez" "email" => array:1 [ 0 => "nuriaderm1@gmail.com" ] "referencia" => array:3 [ 0 => array:2 [ "etiqueta" => "<span class="elsevierStyleSup">a</span>" "identificador" => "aff0005" ] 1 => array:2 [ "etiqueta" => "<span class="elsevierStyleSup">b</span>" "identificador" => "aff0010" ] 2 => array:2 [ "etiqueta" => "<span class="elsevierStyleSup">¿</span>" "identificador" => "cor0005" ] ] ] 1 => array:3 [ "nombre" => "M." "apellidos" => "de Troya-Martín" "referencia" => array:2 [ 0 => array:2 [ "etiqueta" => "<span class="elsevierStyleSup">a</span>" "identificador" => "aff0005" ] 1 => array:2 [ "etiqueta" => "<span class="elsevierStyleSup">b</span>" "identificador" => "aff0010" ] ] ] 2 => array:3 [ "nombre" => "M." "apellidos" => "Frieyro-Elicegui" "referencia" => array:1 [ 0 => array:2 [ "etiqueta" => "<span class="elsevierStyleSup">a</span>" "identificador" => "aff0005" ] ] ] 3 => array:3 [ "nombre" => "R." 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Its use in Spanish public health care hospitals is still limited, however, due to the controversy surrounding its cost.</p> <span class="elsevierStyleSectionTitle">Objectives</span><p id="spar0010" class="elsevierStyleSimplePara elsevierViewall">To determine the cost of MMS with fresh tissue to treat high-risk facial BCC and compare this to the estimated cost of conventional surgery in a Spanish public hospital. A secondary objective was to identify cost-optimization strategies for MMS.</p> <span class="elsevierStyleSectionTitle">Material and methods</span><p id="spar0015" class="elsevierStyleSimplePara elsevierViewall">Cross-sectional study of a consecutive series of patients with high-risk facial BCC who underwent MMS at the Department of Dermatology at Hospital Costa del Sol in Malaga, Spain between July 2006 and December 2007. We performed a descriptive analysis of the clinical characteristics of the patients and surgical factors. We calculated the total and mean cost of MMS and compared the results to the estimated costs of conventional surgery using patients as their own controls. Differences were analyzed according to tumor site and size, histologic subtype, and recurrence.</p> <span class="elsevierStyleSectionTitle">Results</span><p id="spar0020" class="elsevierStyleSimplePara elsevierViewall">Seventy-nine patients (mean age, 62 years) with 81 high-risk facial BCCs, 97.5% of which were primary tumors, underwent MMS. The most common tumor site was the nose (57%) followed by the orbital region (25%). Histology showed that 64% of the tumors were infiltrative or micronodular carcinomas. Tumor-free margins were achieved in all patients, with no more than 2 stages required in 88% of the cases. The most common surgical reconstruction techniques were direct closure (21%) and closure with a local skin flap or graft (71%); the corresponding estimates for conventional surgery were 2% and 89%, respectively. The total and mean cost of MMS was €106 129.07 and €1325.80, respectively (compared to €97700 and €1208.70 for conventional surgery). The difference in mean costs between MMS and conventional surgery was not significant (<span class="elsevierStyleItalic">P</span>=.534).</p> <span class="elsevierStyleSectionTitle">Conclusions</span><p id="spar0025" class="elsevierStyleSimplePara elsevierViewall">MMS is a viable, effective technique that does not generate significantly higher costs than conventional surgery in selected patients with high-risk facial BCC. Certain technical and organizational strategies could contribute to optimizing the cost of MMS.</p>" ] "es" => array:2 [ "titulo" => "Resumen" "resumen" => "<span class="elsevierStyleSectionTitle">Introducción</span><p id="spar0030" class="elsevierStyleSimplePara elsevierViewall">La cirugía micrográfica de Mohs constituye el tratamiento de elección del carcinoma basocelular de alto riesgo, pues ofrece la mayor garantía de curación con la máxima preservación de tejido sano. Sin embargo, su implementación en hospitales del ámbito sanitario público españoles es minoritaria hasta la fecha, debido a que el coste económico de esta técnica continúa siendo motivo de controversia.</p> <span class="elsevierStyleSectionTitle">Objetivo</span><p id="spar0035" class="elsevierStyleSimplePara elsevierViewall">Determinar los costes de la cirugía micrográfica de Mohs en fresco (CMF) en el tratamiento del carcinoma basocelular facial de alto riesgo (CBFR) frente al coste teórico mediante cirugía convencional (CC), en un centro hospitalario del ámbito sanitario público español. Identificar estrategias de optimización de costes en este tipo de cirugía.</p> <span class="elsevierStyleSectionTitle">Material y métodos</span><p id="spar0040" class="elsevierStyleSimplePara elsevierViewall">Estudio transversal de una serie consecutiva de pacientes con CBFR intervenidos mediante CMF en el Servicio de Dermatología del Hospital Costa del Sol desde julio 2006 a diciembre 2007. Se realizó un análisis descriptivo de las características clínicas de la serie y aspectos quirúrgicos. Se realizó un estudio de costes (coste total y coste medio) de la CMF y se compararon con los costes teóricos de la CC, utilizando cada paciente como su propio control. Se analizaron las diferencias por localización, tamaño del tumor, histología y recurrencia.</p> <span class="elsevierStyleSectionTitle">Resultados</span><p id="spar0045" class="elsevierStyleSimplePara elsevierViewall">Se intervinieron con CMF 79 pacientes con 81 CBFR (edad media = 62 años). El 97,5% fueron tumores primarios. La localización más frecuente fue la pirámide nasal (57%) seguida de la región orbitaria (25%). El 64% correspondieron a tipos histológicos infiltrativo y micronodular. La exéresis tumoral mediante CMF se concluyó en todos los casos con márgenes libres, requiriéndose en el 88% únicamente uno o dos estadios. Las técnicas de reconstrucción quirúrgica más empleadas fueron el cierre directo y colgajo local (21 y 71% de los casos respectivamente en la CMF, frente al 2 y 89% en la CC). El coste total y coste medio de la CMF fue de 106.129,07 y 1.325,8 euros respectivamente (frente a 97.770 y 1.208,7 euros de la CC). La diferencia de costes entre ambos procedimientos no fue significativa (p = 0,534).</p> <span class="elsevierStyleSectionTitle">Conclusiones</span><p id="spar0050" class="elsevierStyleSimplePara elsevierViewall">LA CMF es una técnica factible, eficaz y que genera costes que no son significativamente superiores a los de la CC en pacientes seleccionados con CBFR. 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| año/Mes | Html | Total | |
|---|---|---|---|
| 2024 Noviembre | 7 | 19 | 26 |
| 2024 Octubre | 77 | 38 | 115 |
| 2024 Septiembre | 83 | 32 | 115 |
| 2024 Agosto | 96 | 49 | 145 |
| 2024 Julio | 65 | 42 | 107 |
| 2024 Junio | 73 | 42 | 115 |
| 2024 Mayo | 60 | 34 | 94 |
| 2024 Abril | 59 | 38 | 97 |
| 2024 Marzo | 50 | 31 | 81 |
| 2024 Febrero | 52 | 42 | 94 |
| 2024 Enero | 41 | 43 | 84 |
| 2023 Diciembre | 46 | 39 | 85 |
| 2023 Noviembre | 40 | 43 | 83 |
| 2023 Octubre | 46 | 26 | 72 |
| 2023 Septiembre | 49 | 27 | 76 |
| 2023 Agosto | 37 | 24 | 61 |
| 2023 Julio | 57 | 59 | 116 |
| 2023 Junio | 45 | 22 | 67 |
| 2023 Mayo | 51 | 37 | 88 |
| 2023 Abril | 36 | 38 | 74 |
| 2023 Marzo | 34 | 24 | 58 |
| 2023 Febrero | 35 | 24 | 59 |
| 2023 Enero | 42 | 41 | 83 |
| 2022 Diciembre | 39 | 44 | 83 |
| 2022 Noviembre | 19 | 38 | 57 |
| 2022 Octubre | 26 | 31 | 57 |
| 2022 Septiembre | 21 | 58 | 79 |
| 2022 Agosto | 27 | 38 | 65 |
| 2022 Julio | 23 | 47 | 70 |
| 2022 Junio | 16 | 27 | 43 |
| 2022 Mayo | 39 | 46 | 85 |
| 2022 Abril | 41 | 36 | 77 |
| 2022 Marzo | 40 | 52 | 92 |
| 2022 Febrero | 29 | 25 | 54 |
| 2022 Enero | 23 | 40 | 63 |
| 2021 Diciembre | 24 | 38 | 62 |
| 2021 Noviembre | 37 | 41 | 78 |
| 2021 Octubre | 58 | 59 | 117 |
| 2021 Septiembre | 35 | 51 | 86 |
| 2021 Agosto | 32 | 35 | 67 |
| 2021 Julio | 23 | 40 | 63 |
| 2021 Junio | 39 | 23 | 62 |
| 2021 Mayo | 20 | 38 | 58 |
| 2021 Abril | 52 | 63 | 115 |
| 2021 Marzo | 41 | 18 | 59 |
| 2021 Febrero | 45 | 23 | 68 |
| 2021 Enero | 31 | 19 | 50 |
| 2020 Diciembre | 12 | 14 | 26 |
| 2020 Noviembre | 22 | 31 | 53 |
| 2020 Octubre | 15 | 9 | 24 |
| 2020 Septiembre | 21 | 18 | 39 |
| 2020 Agosto | 31 | 29 | 60 |
| 2020 Julio | 17 | 7 | 24 |
| 2020 Junio | 33 | 29 | 62 |
| 2020 Mayo | 58 | 31 | 89 |
| 2020 Abril | 27 | 18 | 45 |
| 2020 Marzo | 40 | 20 | 60 |
| 2020 Febrero | 6 | 3 | 9 |
| 2020 Enero | 0 | 11 | 11 |
| 2019 Diciembre | 0 | 8 | 8 |
| 2019 Noviembre | 0 | 5 | 5 |
| 2019 Octubre | 0 | 5 | 5 |
| 2019 Septiembre | 0 | 4 | 4 |
| 2019 Agosto | 0 | 7 | 7 |
| 2019 Julio | 0 | 4 | 4 |
| 2019 Junio | 0 | 4 | 4 |
| 2019 Mayo | 0 | 42 | 42 |
| 2019 Abril | 0 | 5 | 5 |
| 2019 Marzo | 0 | 6 | 6 |
| 2019 Febrero | 0 | 3 | 3 |
| 2018 Marzo | 1 | 0 | 1 |
| 2018 Febrero | 16 | 5 | 21 |
| 2018 Enero | 20 | 6 | 26 |
| 2017 Diciembre | 23 | 9 | 32 |
| 2017 Noviembre | 19 | 2 | 21 |
| 2017 Octubre | 23 | 7 | 30 |
| 2017 Septiembre | 14 | 7 | 21 |
| 2017 Agosto | 19 | 7 | 26 |
| 2017 Julio | 21 | 5 | 26 |
| 2017 Junio | 29 | 19 | 48 |
| 2017 Mayo | 25 | 13 | 38 |
| 2017 Abril | 22 | 7 | 29 |
| 2017 Marzo | 38 | 3 | 41 |
| 2017 Febrero | 23 | 6 | 29 |
| 2017 Enero | 20 | 10 | 30 |
| 2016 Diciembre | 33 | 18 | 51 |
| 2016 Noviembre | 25 | 5 | 30 |
| 2016 Octubre | 22 | 10 | 32 |
| 2016 Septiembre | 26 | 13 | 39 |
| 2016 Agosto | 26 | 1 | 27 |
| 2016 Julio | 11 | 5 | 16 |
| 2016 Junio | 9 | 1 | 10 |
| 2016 Mayo | 10 | 3 | 13 |
| 2016 Abril | 2 | 4 | 6 |
| 2016 Marzo | 7 | 1 | 8 |
| 2016 Febrero | 8 | 4 | 12 |
| 2016 Enero | 4 | 0 | 4 |
| 2015 Diciembre | 10 | 2 | 12 |
| 2015 Noviembre | 12 | 1 | 13 |
| 2015 Octubre | 6 | 3 | 9 |
| 2015 Septiembre | 6 | 6 | 12 |
| 2015 Agosto | 12 | 1 | 13 |
| 2015 Julio | 35 | 4 | 39 |
| 2015 Junio | 26 | 3 | 29 |
| 2015 Mayo | 70 | 11 | 81 |
| 2015 Abril | 30 | 6 | 36 |
| 2015 Marzo | 32 | 10 | 42 |
| 2015 Febrero | 24 | 13 | 37 |
| 2015 Enero | 19 | 22 | 41 |
| 2014 Diciembre | 28 | 8 | 36 |
| 2014 Noviembre | 22 | 16 | 38 |
| 2014 Octubre | 30 | 18 | 48 |
| 2014 Septiembre | 23 | 14 | 37 |
| 2014 Agosto | 40 | 17 | 57 |
| 2014 Julio | 38 | 16 | 54 |
| 2014 Junio | 42 | 15 | 57 |
| 2014 Mayo | 39 | 12 | 51 |
| 2014 Abril | 41 | 5 | 46 |
| 2014 Marzo | 43 | 18 | 61 |
| 2014 Febrero | 33 | 20 | 53 |
| 2014 Enero | 29 | 12 | 41 |
| 2013 Diciembre | 32 | 9 | 41 |
| 2013 Noviembre | 35 | 21 | 56 |
| 2013 Octubre | 31 | 14 | 45 |
| 2013 Septiembre | 34 | 22 | 56 |
| 2013 Agosto | 35 | 17 | 52 |
| 2013 Julio | 33 | 27 | 60 |
| 2013 Junio | 21 | 19 | 40 |
| 2013 Mayo | 31 | 10 | 41 |
| 2013 Abril | 30 | 18 | 48 |
| 2013 Marzo | 19 | 22 | 41 |
| 2013 Febrero | 18 | 13 | 31 |
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