Elective neck dissection versus positron emission tomography–computed tomography–guided management of the neck in clinically node-negative early oral cavity cancer: A cost–utility analysis
Menée dans un contexte américain, cette étude analyse le rapport coût-efficacité d'un curage ganglionnaire cervical en routine et d'un curage ganglionnaire guidé par tomographie par émission de positons chez des patients atteints d'un cancer de la cavité buccale de stade précoce
BACKGROUND : In early oral cavity cancer, elective neck dissection (END) for the clinically node‐negative (cN0) neck improves survival compared with observation. This paradigm has been challenged recently by the use of positron emission tomography–computed tomography (PET‐CT) imaging in the cN0 neck. To inform this debate, we performed an economic evaluation comparing PET‐CT–guided therapy with routine END in the cN0 neck.
METHODS : Patients with T1‐2N0 lateralized oral tongue cancer were analyzed. A Markov model over a 40‐year time horizon simulated treatment, disease recurrence, and survival from a US health care payer perspective. Model parameters were derived from a review of the literature.
RESULTS : The END strategy was dominant, with a cost savings of $1576.30 USD, an increase of 0.055 quality‐adjusted life years (QALYs), a net monetary benefit of $4303 USD, and a 0.22 life‐year advantage. END was sensitive to variation in cost and utilities in deterministic and probabilistic sensitivity analyses. PET‐CT became the preferred strategy when decreasing occult nodal disease to 18% and increasing the negative predictive value (NPV) of PET‐CT to 89% in 1‐way sensitivity analyses. In probabilistic sensitivity analysis, assuming a cost effectiveness threshold of $50,000 USD/QALY, END was dominant in 64% of simulations and cost effective in 69.8%.
CONCLUSION : END is a cost‐effective strategy compared with PET‐CT in patients who have node‐negative oral cancer. Although lower PET standardized uptake value thresholds would result in fewer false negatives and improved NPV, it is still uncertain that PET‐CT would be cost effective, as this would likely result in more false positive tests.
Cancer , résumé, 2020