Journal of Shandong University (Health Sciences) ›› 2022, Vol. 60 ›› Issue (7): 123-128.doi: 10.6040/j.issn.1671-7554.0.2021.1347

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Cost-effectiveness analysis of staged excision compared with one-stage excision of facial pigmented nevus in children

LI Hongwen1, ZHOU Zifu1, WANG Song1, HUO Ran1,2   

  1. 1. Department of Plastic and Cosmetic Surgery, Shandong Provincial Hospital, Cheeloo College of Medicine, Shandong University, Jinan 250021, Shandong, China;
    2. Department of Plastic and Cosmetic Surgery, Shandong Provincial Hospital Affiliated to Shandong First Medical University, Jinan 250021, Shandong, China
  • Published:2022-07-27

Abstract: Objective To compare the clinical effectiveness of one-stage excision and staged excision in children with congenital facial nevus by using clinical health economics evaluation method and to evaluate their cost-effectiveness. Methods A retrospective analysis was performed on the clinical data of 58 children with congenital facial nevus who visited Shandong Provincial Hospital from June 2018 to June 2019. The patients were divided into one-stage excision group(n=30)and staged excision group(n=28)according to the surgical operation. The length, width and area of the scar six months after the surgery were collected to evaluate the effectiveness of the surgery. The direct, indirect costs of two groups were also collected. Cost-effectiveness was analyzed using incremental cost-effectiveness ratio(ICER). Results All the patients completed the operation successfully. The total cost of the staged excision group was significantly higher than that of the one-stage excision group [14 769.99(13 971.52,14 769.99)yuan vs 7 824.52(6 620.51,8 445.64)yuan, P<0.001]. The postoperative area reduction of the scar in the staged excision group was 0.95(0.29,2.59)cm2, which was higher than that in the one-staged group [0.29(0.1,0.79)cm2; P=0.02]. The ICER analysis indicated that the patients in one-stage excision group spent 26 981.10 yuan for 1 cm2 area reduction and the patients in staged excision group spent 15 547.36 yuan for 1 cm2 area reduction. Conclusion Compared with the one-stage excision, the staged excision of congenital pigmented nevus on the face does not increase the length and width of the scar after the operation even for the wider lesions. Although staged excision increases extra costs for the patient, but it is still a better surgical treatment of pigmented nevi with a better ICER.

Key words: Congenital melanocytic nevi, Staged excision, One-stage excision, Cost-effectiveness analysis

CLC Number: 

  • R622+.9
[1] Krengel S, Scope A, Dusza SW, et al. New recommendations for the categorization of cutaneous features of congenital melanocytic nevi[J]. J Am Acad Dermatol, 2013, 68(3): 441-451.
[2] Krengel S, Hauschild A, Schäfer T. Melanoma risk in congenital melanocytic naevi: a systematic review[J]. Br J Dermatol, 2006, 155(1): 1-8.
[3] Masnari O, Schiestl C, Rössler J, et al. Stigmatization predicts psychological adjustment and quality of life in children and adolescents with a facial difference[J]. J Pediatr Psychol, 2013, 38(2): 162-172.
[4] Neuhaus K, Landolt M, Vojvodic M, et al. Surgical treatment of children and youth with congenital melanocytic nevi: self- and proxy-reported opinions[J]. Pediatr Surg Int, 2020, 36(4): 501-512.
[5] 周子芙,张瑾,王耸,等.78例儿童先天性面部色素痣分期切除结合外扩张的美容效果[J].山东大学学报(医学版), 2021, 59(2): 71-75. ZHOU Zifu, ZHANG Jin, WANG Song, et al. Cosmetic effects of staged resection of congenital facial nevus combined with external dilatation in 78 children [J]. Journal of Shandong University(Health Sciences), 2021, 59(2): 71-75.
[6] Ott H, Krengel S, Beck O, et al. Multidisciplinary long-term care and modern surgical treatment of congenital melanocytic nevi—recommendations by the CMN surgery network[J]. J Dtsch Dermatol Ges, 2019, 17(10): 1005-1016.
[7] Arad E, Zuker RM. The shifting paradigm in the management of giant congenital melanocytic nevi: review and clinical applications[J]. Plast Reconstr Surg, 2014, 133(2): 367-376.
[8] Liu H, Yu N, Shi J, et al. A new modified S-plasty for skin defect closure[J]. Aesthetic Plast Surg, 2015, 39(1): 100-105.
[9] Iida N, Watanabe A, Kusano T. Usefulness of S-shaped incision in large nevus sequential excision[J]. Plast Reconstr Surg Glob Open, 2014, 2(10): e224.
[10] Mutti LdA, Mascarenhas MRM, Paiva JMGd, et al. Giant congenital melanocytic nevi: 40 years of experience with the serial excision technique[J]. An Bras Dermatol, 2017, 92(2): 256-259.
[11] Sanders GD, Neumann PJ, Basu A, et al. Recommendations for conduct, methodological practices, and reporting of cost-effectiveness analyses: second panel on cost-effectiveness in health and medicine[J]. JAMA, 2016, 316(10): 1093-1103.
[12] Sanders GD, Maciejewski ML, Basu A. Overview of cost-effectiveness analysis[J]. JAMA, 2019, 321(14): 1400-1401.
[13] OMahony JF. Does cost-effectiveness analysis really need to abandon the incremental cost-effectiveness ratio to embrace net benefit?[J]. Pharmacoeconomics, 2020, 38(8): 777-779.
[14] Leshem D, Gur E, Meilik B, et al. Treatment of congenital facial nevi[J]. J Craniofac Surg, 2005, 16(5): 897-903.
[15] 祁方家,卢建龙,冯莎,等.药物经济学评价中常见的成本及其测算方法[J].上海医药, 2015, 36(1): 7-9, 13. QI Fangjia, LU Jianlong, FENG Sha, et al. Common costs and their estimation methods in pharmacoeconomics [J]. Shanghai Medical & Pharmaceutical Journal, 2015, 36(1): 7-9, 13.
[16] Breuninger H, Häfner HM. Serial excision with power stretching for large and giant melanocytic nevi of the trunk[J]. J Dtsch Dermatol Ges, 2019, 17(8): 852-855.
[17] 顾子春,李华,叶学红,等.分次切除在皮肤病损治疗中的应用价值[J].全科医学临床与教育, 2007, 5(2): 119-121. GU Zichun, LI Hua, YE Xuehong, et al. The application value of fractional resection in treatment of skin lesion [J]. Clinical Education of General Practice, 2007, 5(2): 119-121.
[18] Lim JM, Oh Y, Lee SH, et al. Comparison of treatment options for small to medium congenital melanocytic nevi: a retrospective review of 119 cases[J]. Lasers Surg Med, 2019, 51(1): 62-67.
[19] Fahradyan A, Wolfswinkel EM, Tsuha M, et al. Cosmetically challenging congenital melanocytic nevi[J]. Ann Plast Surg, 2019, 82(5S Suppl 4): S306-S309.
[20] Hassanein AH, Rogers GF, Greene AK. Management of challenging congenital melanocytic nevi: outcomes study of serial excision[J]. J Pediatr Surg, 2015, 50(4): 613-616.
[21] 王振宇,逯艳,余睿芳,等.鱼嘴形切口在色素痣分次手术切除中的临床应用[J].中国美容医学, 2019, 28(4): 125-127. WANG Zhenyu, LU Yan, YU Ruifang, et al. The clinical application of fish-mouth shaped incision used in fractional surgical resection of pigmented nevus [J]. Chinese Journal of Aesthetic Medicine, 2019, 28(4): 125-127.
[22] Fife DJ, Alam M. Alternative techniques for reduction of scar length during staged excision[J]. J Am Acad Dermatol, 2011, 65(4): 811-818.
[23] Neumann PJ, Sanders GD. Cost-effectiveness analysis 2.0[J]. N Engl J Med, 2017, 376(3): 203-205.
[24] 张楠,石学峰,吴晶.增量成本效果比在卫生技术评估中的应用[J].中国卫生政策研究, 2012, 5(2): 64-68. ZHANG Nan, SHI Xuefeng, WU Jing. The application of incremental cost-effectiveness ratio to health technology assessment [J]. Chinese Journal of Health Policy, 2012, 5(2): 64-68.
[25] 陈英耀,董恒进,吕军,等.临床经济学概述[J].中华医院管理杂志, 2000, 16(6): 54-56.
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