Cost Effectiveness of Intermediate-Risk Squamous Cell Carcinoma Treated with Mohs Micrographic Surgery Compared with Wide Local Excision

Mendeley Supplemental Figure 1: Tornado Diagram. This diagram shows the sensitivity of the model to a +/- 50% change in each variable. Increasing the value of a probability, cost, or effectiveness variable (red colored bar) results in a certain change in the incremental cost-effectiveness ratio (ICER, displayed on the X-axis) output of the model while decreasing the value (blue colored bar) results in an alternative change. The baseline model demonstrated that MMS was superior to WLE in both cost and effectiveness resulting in a negative ICER (WLE was dominated). The model’s ICER output was most sensitive to the probability of NR after WLE (first row in the diagram). However, as discussed in the manuscript, a 50% (or even 100%) reduction in the variable from 3.97% to 1.99% (or 3.97% to 0.00%) would not result in WLE being cost-effective; a value of 1.99% results in an ICER of around $0, so costs could be equivalent but there is increased effectiveness with MMS. If one were to test extreme alterations in the variables, the X-axis could be expanded to the right to include $50,000 (the willingness to pay threshold for our model). This point would be where one would consider whether the proposed intervention (MMS) was worth paying for. However, we did not encounter this point of equivalence during sensitivity analysis.Mendeley补充图1：龙卷风图（Tornado Diagram）。该图展示了模型对各变量±50%波动的敏感性。概率、成本或效果变量的取值上调时（红色柱条），会使模型输出的增量成本效果比（incremental cost-effectiveness ratio, ICER）发生特定变化；而变量取值下调时（蓝色柱条）则会产生另一类变化。基准模型显示，MMS在成本与效果两方面均优于WLE，因此得到负向的ICER值（WLE被占优）。 模型的ICER输出对WLE术后无应答（No Response, NR）概率最为敏感，即图中的第一行。不过正如稿件中所讨论的，将该变量从3.97%降低50%（甚至100%）至1.99%（或降至0.00%），并不会使WLE具备成本效果优势；当变量取值为1.99%时，ICER值约为0美元，此时二者成本相当，但MMS的效果更优。 若对变量开展极端波动测试，可将横轴向右延展至50000美元（本模型的支付意愿阈值），该点位即为判断干预措施（MMS）是否具备支付价值的临界值。但在本次敏感性分析中，并未触及该等效临界点。