A cost-effective analysis found that the addition of elective neck dissection to primary surgery in patients with oral cavity cancer showed a cost reduction and improved health outcomes, reported researchers from the University of California, San Diego. The findings were published online in the Journal of Clinical Oncology.
For the study, the researchers used a Markov model to stimulate primary, adjuvant, and salvage therapy; disease recurrence; and survival in patients with T1/T2 clinically node-negative oral cavity squamous cell carcinoma. Transition probabilities were derived from clinical trial data and costs (in 2015 US dollars) and health utilities were estimated from the literature. The researchers also conducted one-way and probabilistic sensitivity analyses to examine model uncertainty.
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The researchers’ base care model found that over a lifetime, compared with primary surgery alone, the addition of elective neck dissection to primary surgery lowered overall costs by $6000 and improved effectiveness by 0.42 quality-adjusted life years (QALYs). The reduction in overall cost despite the added neck dissection was attributed to less use of salvage therapy. The one-way sensitivity analysis showed that the model was most sensitive to assumptions about disease recurrence, survival, and the health utility reduction from a neck dissection. At a willingness-to-pay threshold of $100,000/QALY, the probabilistic sensitivity analyses indicated that treatment with elective neck dissection was cost-effective 76% of the time.
This study demonstrated that the addition of elective neck dissection in conjunction with primary surgery is a cost-effective treatment strategy with better outcomes for patients with early-stage oral cavity cancer, concluded the researchers.--Eileen Koutnik-Fotopoulos
