Reconstruction Following Mohs Surgery with Dehydrated Human Amnion Chorion Membrane (DHACM): A Cost-Effectiveness Analysis

Introduction: The purpose of this study was to examine the cost-effectiveness of placental allografts as a nonoperative surrogate to autologous tissue-based methods of defect reconstruction on the face, head, and dorsal hand following Mohs micrographic surgery (MMS).Methods:This study was a 5-year retrospective, analysis comparing propensity-matched cohorts of eligible Mohs surgery patients treated with a placental allograft (DHACM, dehydrated human amnion/chorion membrane) vs. autologous tissue-based repairs (SOC). Costs on day 0 through discharge were used for a cost-effectiveness analysis (CEA) and an incremental cost-effectiveness ratio (ICER).Results:Four-hundred-twenty-nine propensity-matched patients were retrospectively divided into treatment (DHACM) and standard of care (SOC) cohorts in a 1:2 match. High risk reconstructions had favorable results with DHACM (Fig 1). MMS defects treated with DHACM had significantly lower rates of adverse post-repair sequelae; infection (p=0.0114), dehiscence (p=0.0189), necrosis (p=0.0349), hematoma (p=0.0066) and scar revisions (p=0.0044), resulting in an average savings of $409.55 for high-risk post-MMS defects and a dominant ICER. The primary reconstruction cost increased with DHACM (p .0001), while the cumulative cost of care was similar between groups (p > .05).Discussion: Closure of post-MMS defects with DHACM resulted in significantly lower rates of adverse post-repair sequelae (2.8% vs. 21.3%, p .0001), which offsets the upfront cost of DHACM, resulting in shorter lengths of care and favorable cosmetic outcomes. DHACM is an effective repair approach for surgical wounds in elderly patients that cannot be primarily closed or are at risk for adverse post-repair sequelae.References: