Abstract
Background: Despite ongoing controversy, planned node dissection (ND) remains a common treatment strategy after radical chemoradiotherapy (CRT) for locally advanced nodal metastases in patients with HNSCC. Accurate detection of persistent disease using combined Positron Emission and Computerised Tomography (PET-CT) could reduce unnecessary and expensive node
dissections (ND) in low-risk patients and potentially improve overall outcomes.
Methods: 564 patients with N2/N3 oropharyngeal, laryngeal, oral, hypopharyngeal or occult HNSCC were randomized (1:1) to receive either planned ND (before or after CRT), or PET-CT surveillance (CRT followed by PET-CT, with ND administered if incomplete response in the neck nodes). To accurately inform reimbursement decisions, individual patient data from the trial was used to assess within-trial (2-year) cost-effectiveness of PET-CT surveillance versus planned ND from an NHS secondary care perspective. Health benefit was measured using quality-adjusted life-years (QALYs) and costs are reported in 2015 GBP. Probabilistic analysis was conducted using bootstrap methods.
Results: PET-CT surveillance was cost-effective over the trial period, producing an average per-person cost saving of £1,415 (95% CI: -607 to -2,218) and a health gain of 0.07 QALYs (95% CI: -0.04 to 0.19) compared to planned ND. The average cost was £12,127 (95% CI: 11,601 to 12,686) for PET-CT surveillance vs. £13,542 (95% CI: 12,968 to 14,131) for planned ND; the average QALYs were 1.26 (95% CI: 1.18 to 1.34) vs. 1.19 (95% CI: 1.10 to 1.27). At a £20,000 per QALY threshold, the probability that PET-CT was the cheapest, most effective and most cost-effective strategy was 99%, 91%, and 98%, respectively. Expanding the analysis to include additional NHS, personal social services and societal costs increased the expected costs for each arm but did not alter the overall cost-effectiveness of PET-CT surveillance.
Conclusions: Results of the economic evaluation indicate that PET-CT surveillance is cost-effective over a short time horizon.
dissections (ND) in low-risk patients and potentially improve overall outcomes.
Methods: 564 patients with N2/N3 oropharyngeal, laryngeal, oral, hypopharyngeal or occult HNSCC were randomized (1:1) to receive either planned ND (before or after CRT), or PET-CT surveillance (CRT followed by PET-CT, with ND administered if incomplete response in the neck nodes). To accurately inform reimbursement decisions, individual patient data from the trial was used to assess within-trial (2-year) cost-effectiveness of PET-CT surveillance versus planned ND from an NHS secondary care perspective. Health benefit was measured using quality-adjusted life-years (QALYs) and costs are reported in 2015 GBP. Probabilistic analysis was conducted using bootstrap methods.
Results: PET-CT surveillance was cost-effective over the trial period, producing an average per-person cost saving of £1,415 (95% CI: -607 to -2,218) and a health gain of 0.07 QALYs (95% CI: -0.04 to 0.19) compared to planned ND. The average cost was £12,127 (95% CI: 11,601 to 12,686) for PET-CT surveillance vs. £13,542 (95% CI: 12,968 to 14,131) for planned ND; the average QALYs were 1.26 (95% CI: 1.18 to 1.34) vs. 1.19 (95% CI: 1.10 to 1.27). At a £20,000 per QALY threshold, the probability that PET-CT was the cheapest, most effective and most cost-effective strategy was 99%, 91%, and 98%, respectively. Expanding the analysis to include additional NHS, personal social services and societal costs increased the expected costs for each arm but did not alter the overall cost-effectiveness of PET-CT surveillance.
Conclusions: Results of the economic evaluation indicate that PET-CT surveillance is cost-effective over a short time horizon.
| Original language | English |
|---|---|
| Publication status | Published - 2015 |
| Event | 2015 ASCO Annual Meeting - Illinois, Chicago, United States Duration: 29 May 2015 → 2 Jun 2015 |
Conference
| Conference | 2015 ASCO Annual Meeting |
|---|---|
| Country/Territory | United States |
| City | Chicago |
| Period | 29/05/15 → 2/06/15 |
