OBJECTIVES:There are potential benefits of non-surgical treatments in patients with superficial and low risk non-melanoma skin tumors. Our model evaluates the cost-effectiveness of photodynamic therapy in the treatment of low-risk superficial basal cell tumors.

METHODS: A decision tree was built adopting the perspective of the Brazilian Public Health System (SUS) and a time horizon of up to 5 years. From the chosen strategy, the conditional events included lesion cure, cosmetic resolution, recurrence and second intervention. Surgical removal is assumed as the second intervention in all cases of failure/relapse. Based on systematic reviews, among non-surgical treatments, despite the higher rates of recurrence, there is a potential benefit of photodynamic therapy in cosmetic outcomes in relation to surgical removal. The costs included the photodynamic therapy procedure (microcosting) and adjusted average cost of an admission to the surgical withdrawal (macrocosting). The primary endpoint was the resolution with good cosmetic outcome. Alternative scenarios, deterministic and probabilistic sensitivity analyzes were conducted with the Microsoft Excel® software. No discount rates were adopted (exchange rate: US$ 1 = R$ 3.84).

RESULTS: The ICER of photodynamic therapy compared to surgical removal was US$ 2,001.13 for each additional resolution with good cosmetic outcome. The variables with the major impact were the Relative Risk of poor cosmetic outcome, the adjustment value of the SUS reimbursement table and the probability of poor cosmetic outcome. The model was robust within the ICER amplitude of US$ 1,174.85 to US$ 3,355.73. All the Monte Carlo trials were below the threshold of R$ 30,000.00 (approximately 1 GDP per capita). Nevertheless, when the cosmetic benefit is not taken into account, photodynamic therapy is dominated by surgical withdrawal in all scenarios.

CONCLUSIONS: Despite the worst performance in relation to recurrence, photodynamic therapy is a cost-effective alternative in situations where the cosmetic benefit has a major impact on the treatment decision.