Placental Allograft Reconstruction of Cutaneous Wounds Following Mohs Surgery: A Propensity Score-Matched Comparative Cost-Effectiveness Analysis
May 2025 | Volume 24 | Issue 5 | 450 | Copyright © May 2025
Published online April 30, 2025
Julia Toman MD MPH FACSa, John R. Adams MDb,c, Melanie Choi PA-Cd, David Mason MDe, Brandon S. Hubbs MS MAf, R. Allyn Forsyth PhDe,g, Gary S. Rogers MDh
aDivision of Facial Plastics and Reconstructive Surgery, Department of Otolaryngology Head and Neck Surgery, University of South Florida, Tampa, FL
bAdvanced Dermatology and Skin Cancer Center, Manhattan, KS
cDivision of Dermatology, Department of Internal Medicine, University of Kansas School of Medicine, Wichita, KS
dPrivate practice, The Dermatology Specialists, NY
eDepartment of Clinical Research, MiMedx Group, Inc., Marietta, GA
fBiostatistics Consulting, Alpharetta, GA
gDepartment of Biology, San Diego State University, San Diego, CA
hDivision of Dermatology, Beverly Hospital, Beth Israel Lahey Health, Beverly, MA; Tuft University School of Medicine, Boston, MA
Abstract
Background: The purpose of this study was to examine the cost-effectiveness of placental allograft 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. 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 meeting the entry/exclusion criteria were divided into treatment (dHACM) and Standard of Care (SOC) cohorts in a 1:2 match. The study population was 78.8% male, with a mean age of 77.8 +/- 9.3 years. The primary reconstruction cost increased with dHACM (P<.0001), while the cumulative cost of care was similar between groups (P>0.05). 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.
Conclusion: In subjects meeting the entry/exclusion criteria, 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 offset the upfront cost of dHACM, resulting in shorter lengths of care and favorable cosmetic outcomes. dHACM may be a cost-effective approach for surgical wounds in select patient populations.
Citation: Toman J, Adams JR, Choi M, et al. Placental allograft reconstruction of cutaneous wounds following Mohs surgery: a propensity score-matched comparative cost-effectiveness analysis. J Drugs Dermatol. 2025;24(5):450-456. doi:10.36849/JDD.8436
INTRODUCTION
Basal and squamous cell carcinomas are the most common cancers in the United States with an alarming 80% increase in recent years.1,2 This is likely to increase as the population ages.3 Mohs micrographic surgery (MMS), known for its low recurrence rates, is among the preferred techniques for resecting these skin tumors when complex, large, or recurrent.4 The subsequent cutaneous reconstruction plays a pivotal role in restoring form, function, and quality of life for patients post-MMS.5 The impact of altered appearance or reduced function or well-being underscores the importance of effective interventions.6 In anatomical sites with elevated cosmetic and functional risk (such as the face, scalp, hands, and feet), innovative approaches are essential.7,8 For elderly patients who are not suitable surgical candidates for autologous flaps, skin grafts, or second-intent healing is contraindicated, nonoperative techniques such as placental allografts, have emerged as a promising solution9 that improve cosmesis and preserve functional ability.10 Allografts promote dermal reconstruction and have demonstrated positive outcomes in various scenarios, including randomized controlled trials for hard-to-heal wounds,11-15 pediatric burns,16 and post-MMS defects.17 However, concerns regarding overall costs have hindered their widespread adoption.18,19
