Recommendations for Cost-Conscious Treatment of Basal Cell Carcinoma

Abstract

Abstract Background Basal cell carcinoma (BCC) affects 3.3 million Americans annually. Treatment modalities for BCC include many surgical and nonsurgical options. The cost of BCC treatment can pose a substantial burden to patients and the healthcare system. Cost can be an important consideration in BCC treatment planning. Objective We present an approach to the management of BCC when cost reduction is a priority. Methods A PubMed literature search identified studies on effectiveness of current BCC therapies. Treatment prices were obtained from the Medicare National Fee Schedule, GoodRx, and pharmaceutical companies. The American Academy of Dermatology’s (AAD) guidelines for treating BCC were used to develop recommendations for cost-reductive treatment. Results The cost of treating a primary superficial BCC 10 cm with aggressive behavior) was $465–3311 with radiation, $139,560 with vismodegib, $144,452 with sonidegib, ~ $44.5 with cisplatin (medication cost only), and at least $184,836 with cemiplimab-rwlc. Conclusions For a primary superficial BCC < 0.5 cm arising on Area M, the cost-conscious algorithm prioritizes C&E or cryosurgery. For a primary nodular BCC 1.1–2 cm arising on Area L, the cost-conscious algorithm prioritizes C&E, cryosurgery, or 5-FU. For a giant BCC, the cost-conscious algorithm identifies superficial radiation therapy as first line.

Keywords

• Dermatology
• Basal cell carcinoma
• Cost of nonmelanoma skin cancer