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 .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