| Cost-effectiveness of CT and PET-CT for determining the need for adjuvant neck dissection in locally advanced head and neck cancer. | |
| | |
MedLine Citation:
|
PMID: 19833820 Owner: NLM Status: MEDLINE |
Abstract/OtherAbstract:
|
BACKGROUND: Patients with node-positive head and neck squamous cell carcinomas (HNC) have a significant risk of residual disease (RD) in the neck after treatment, despite optimal chemoradiotherapy (CRT). Adjuvant neck dissection (ND) after CRT has been considered standard treatment, but its morbidity has led investigators to consider using post-CRT imaging to determine the need for surgery. We analyzed the cost-effectiveness of computed tomography (CT) and positron emission tomography-computed tomography (PET-CT) as predictors of the need for ND compared with ND for all patients. MATERIALS AND METHODS: We developed a Markov model to describe health states in the 5 years after CRT for HNC in a 50-year-old man. We compared three strategies: dissect all patients, dissect patients with RD on CT, and dissect patients with RD on PET-CT. Probabilistic sensitivity analyses were carried out to model uncertainty in PET-CT performance, up-front and salvage dissection costs, and patient utilities. RESULTS: ND only for patients with RD on PET-CT was the dominant strategy over a wide range of realistic and exaggerated assumptions. Probabilistic sensitivity analyses confirmed that the PET-CT strategy was almost certainly cost-effective at a societal willingness-to-pay threshold of $500,000/quality-adjusted life year. CONCLUSION: Adjuvant ND reserved for patients with RD on PET-CT is the dominant and cost-effective strategy. |
| | |
Authors:
|
D J Sher; R B Tishler; D Annino; R S Punglia |
Publication Detail:
|
Type: Journal Article Date: 2009-10-15 |
Journal Detail:
|
Title: Annals of oncology : official journal of the European Society for Medical Oncology / ESMO Volume: 21 ISSN: 1569-8041 ISO Abbreviation: Ann. Oncol. Publication Date: 2010 May |
Date Detail:
|
Created Date: 2010-04-28 Completed Date: 2010-08-17 Revised Date: 2011-09-21 |
Medline Journal Info:
|
Nlm Unique ID: 9007735 Medline TA: Ann Oncol Country: England |
Other Details:
|
Languages: eng Pagination: 1072-7 Citation Subset: IM |
Affiliation:
|
Department of Radiation Oncology, Dana-Farber Cancer Institute and Brigham and Women's Hospital, Boston, MA 02115, USA. dsher@lroc.harvard.edu |
Export Citation:
|
APA/MLA Format Download EndNote Download BibTex |
| MeSH Terms | |
Descriptor/Qualifier:
|
Antineoplastic Combined Chemotherapy Protocols
/
therapeutic use Carcinoma, Squamous Cell / economics*, therapy Combined Modality Therapy Computer Simulation Cost-Benefit Analysis Head and Neck Neoplasms / economics*, therapy Humans Lymphatic Metastasis Male Markov Chains Middle Aged Models, Economic* Neck Dissection* Neoplasm Recurrence, Local / diagnosis*, economics Positron-Emission Tomography / utilization* Quality-Adjusted Life Years Radiotherapy Dosage Sensitivity and Specificity Tomography, X-Ray Computed / utilization* Treatment Outcome |
| Grant Support | |
ID/Acronym/Agency:
|
K07 CA118269-01/CA/NCI NIH HHS; K07 CA118269-02/CA/NCI NIH HHS; K07 CA118269-03/CA/NCI NIH HHS; K07 CA118269-04/CA/NCI NIH HHS; K07 CA118269-05/CA/NCI NIH HHS |
| Comments/Corrections | |
From MEDLINE®/PubMed®, a database of the U.S. National Library of Medicine
Previous Document: A randomized, phase III multicenter trial of gemcitabine in combination with carboplatin or paclitax...
Next Document: Efficacy of radionuclide treatment DOTATATE Y-90 in patients with progressive metastatic gastroenter...