Management of the N0 neck in early stage oral squamous cell cancer: A modeling study of the cost-effectiveness
Management of the N0 neck in early stage oral squamous cell cancer: A modeling study of the cost-effectiveness
复制标题
DOI：
10.1016/j.oraloncology.2013.05.001
复制
发表时间：
2013-08-01
期刊：
影响因子：
4.8
通讯作者：
Rovers, Maroeska M.
中科院分区：
文献类型：
--
作者：
Govers, Tim M.;Takes, Robert P.;Rovers, Maroeska M.
目的：评价cT（1-2）N（0）口腔鳞状细胞癌5种诊断和治疗策略的成本-效果。采用马尔可夫决策分析模型对（1）选择性颈清扫术（END）、（2）观察等待（WW）、（3）基因表达谱（GEP）后进行颈清扫术（ND）或WW、（4）前哨淋巴结（SLN）手术后行ND或WW;（5）GEP和SLN（GEP阳性者）手术后行ND或WW。不确定性是解决使用单向和概率敏感性analysis.Results：基本情况分析表明，SLN程序，其次是ND或WW是最有效和最具成本效益的策略。与直接END相比，每增加一个QALY，增量成本效果比为3356。不确定性分析表明，该模型对假设的隐匿性转移发生率和效用值的变化敏感。SLN被发现有最高的概率（66%）的成本效益的五个战略，愿意支付（原文如此）80,000每QALY.Conclusions：鉴于目前的证据和成本的SLN程序，其次是ND或WW似乎是最具成本效益的战略，用于诊断和治疗口腔鳞状细胞癌患者。我们的模型为该领域未来的诊断和治疗研究提供了基础，并表明进一步了解这一人群的生活质量是非常有价值的。(C)2013爱思唯尔有限公司保留所有权利。
Objectives: To assess the cost-effectiveness of five strategies for diagnosing and treating cT(1-2)N(0) oral squamous cell cancer.Materials and methods: A Markov decision analytic model was used to evaluate the cost-effectiveness of (1) elective neck dissection (END), (2) watchful waiting (WW), (3) gene expression profiling (GEP) followed by neck dissection (ND) or WW, (4) sentinel lymph node (SLN) procedure followed by ND or WW, and (5) GEP and SLN (for positive GEP) followed by ND or WW. Uncertainty was addressed using one-way and probabilistic sensitivity analyses.Results: Base-case analysis showed that SLN procedure followed by ND or WW was the most effective and most cost effective strategy. Compared with direct END the incremental cost effectiveness ratio was (sic)3356 per QALY gained. Uncertainty analysis showed that the model was sensitive to changes in assumed occult metastases incidence and utility values. SLN was found to have the highest probability (66%) of being cost-effective of the five strategies, at a willingness to pay of (sic)80,000 per QALY.Conclusions: Given the current evidence and costs the SLN procedure followed by ND or WW appears to be the most cost effective strategy for diagnosing and treating oral squamous cell cancer patients. Our model provides the foundation for future diagnostic and therapeutic research in this field and shows that further information on quality of life in this population is highly valuable. (C) 2013 Elsevier Ltd. All rights reserved.