Implementing AF-Raman scanning for testing basal cell skin carcinoma clearance during Mohs’ micrographic surgery: a replacement technology evaluation

We provide a time-benefit analysis from the perspective of the UK National Health Service (NHS) as payer when intraoperative AF-Raman scanning is used as a replacement, or load reducing technology, for patients with high-risk basal cell carcinoma being treated by staged Mohs’ micrographic surgery. We explore the potential to treat an additional patient using the new technology compared with standard care that relies on intraoperative frozen section histopathology. Results pertain to a multi-patient setting, built from a simple, single patient decision tree pathways model of Mohs’ surgery. Parameterisation is informed by results drawn from the Nottingham diagnostic accuracy study. The main metric of comparison is the expected duration of operations. Main baseline result: the expected duration of operations are 416 min when 6 patients are treated using intraoperative AF-Raman scanning and 375.4 min when 5 patients are treated under standard care, the difference is just over 40 min. Offsetting the costs a hospital would incur to supply that additional time on each day of operations are (i) the NHS reimbursement it is paid for treating an extra patient (averaging £2,255), and (ii) by daily gains of approximately 10 man hours of freed histopathology resource that can be reallocated to other work.