With regard to the comments about the 5 possible forms of bias, we would like to refer to the elaborate answer our clinical investigators already gave (see reference 1 herein) to remarks that were identical to those Otley has now made.
In our study we used the microcosting method, which is a detailed inventory and measurement of the resources used. The main advantage of this method is that it allows others to see how well the analysis matches their own situation where patterns of care may differ.2 As concerns the pathology costs, it makes clear that the pattern of care in our study differs from that in the United States with regard to the specific professional who performs the pathology analysis. However, this difference (ie, using a separate pathologist) does not automatically lead to an increase in total costs for MMS. After all, it is important to keep in mind that time associated with microscopic evaluation is a true resource use, which should be translated into costs, regardless of who performs the analysis.
Essers BAB, Dirksen CD, Neumann HAM. Cost-effectiveness of Mohs Micrographic Surgery vs Surgical Excision for Basal Cell Carcinoma of the Face—Reply. Arch Dermatol. 2006;142(9):1231-1244. doi:10.1001/archderm.142.9.1235-b