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PET-CT surveillance for advanced head and neck cancer : a cost-effective alternative to planned neck dissection?
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Smith, A. F., Hall, P. S., Hulme, Charles, McConkey, Christopher C., Dunn, Janet A., Rahman, J. and Mehanna, H. (2016) PET-CT surveillance for advanced head and neck cancer : a cost-effective alternative to planned neck dissection? Annals of Oncology, 27 (Supplement 6). 952PD. doi:10.1093/annonc/mdw376.05
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Official URL: https://doi.org/10.1093/annonc/mdw376.05
Abstract
Background: Despite controversy, planned neck dissection (ND) remains standard treatment for patients with locally advanced head and neck squamous cell carcinoma after radical chemo-radiotherapy. FDG-PET-CT scanning has demonstrated high negative predictive values for persistent disease, and could thereby enable low risk patients to be spared from unnecessary surgery. Evidence of the cost-effectiveness of PET-CT surveillance strategies is limited however, and no evaluations have yet been conducted from a UK perspective.
Methods: An economic evaluation was conducted to assess the lifetime cost-effectiveness of PET-CT surveillance versus planned ND from a UK secondary care perspective. Cost and health outcomes associated with the initial 6-month treatment period (CRT +/- ND) were derived from individual data on 564 patients from a recent UK multicentre randomised controlled trial (PET-Neck). Subsequent outcomes were derived using a constructed Markov model to track patients through four health states: disease-free, local recurrence, distant recurrence and dead. Model inputs were derived from trial data and literature sources.
Results: PET-CT surveillance results in a lifetime cost saving of -£1,485 (95% CI: -2,815 to 159) and health gain of +0.13 (95% CI: -0.49 to +0.79) quality-adjusted life-years (QALYs) per patient. The intervention therefore dominates standard care, being more effective and less costly, with an incremental net benefit (INB) of +0.21 QALYs (95% CI: -0.41 to +0.85). At a willingness-to-pay per QALY threshold of £20,000, PET-CT is associated with a 75% probability of being cost-effective, dropping to 68% at a £100,000/QALY threshold. The intervention remained cost-effective when considering a broader NHS and personal social services perspective; however, uncertainty around the mean cost-effectiveness values was wide.
Conclusions: PET-CT surveillance appears to be cost-effective, leading to expected lifetime cost savings and a marginal health increment. There is significant uncertainty in the longer term which may warrant additional survivor-ship research.
| Item Type: | Journal Item | ||||||
|---|---|---|---|---|---|---|---|
| Subjects: | R Medicine > RC Internal medicine > RC0254 Neoplasms. Tumors. Oncology (including Cancer) | ||||||
| Divisions: | Faculty of Medicine > Warwick Medical School > Health Sciences > Clinical Trials Unit Faculty of Medicine > Warwick Medical School |
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| Journal or Publication Title: | Annals of Oncology | ||||||
| Publisher: | Oxford University Press | ||||||
| ISSN: | 0923-7534 | ||||||
| Official Date: | 1 October 2016 | ||||||
| Dates: |
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| Volume: | 27 | ||||||
| Number: | Supplement 6 | ||||||
| Article Number: | 952PD | ||||||
| DOI: | 10.1093/annonc/mdw376.05 | ||||||
| Status: | Peer Reviewed | ||||||
| Publication Status: | Published | ||||||
| Access rights to Published version: | Restricted or Subscription Access |
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