A cost-effectiveness analysis of positron emission tomography-computed tomography surveillance versus up-front neck dissection for management of the neck for N2 disease after chemoradiotherapy

Authors

  • Amy Rabalais MD,

    1. Department of Otolaryngology–Head and Neck Surgery, Louisiana State University Health Sciences Center, New Orleans, Louisiana
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  • Rohan R. Walvekar MD,

    Corresponding author
    1. Department of Otolaryngology–Head and Neck Surgery, Louisiana State University Health Sciences Center, New Orleans, Louisiana
    • Assistant Professor, Department of Otolaryngology–Head Neck Surgery, LSU Health Sciences Center, 533 Bolivar Street, Suite 566, New Orleans, LA 70112
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  • Jonas T. Johnson MD,

    1. Department of Otolaryngology, University of Pittsburgh, Pittsburgh, Pennsylvania
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  • Kenneth J. Smith MD, MS

    1. Department of Internal Medicine, University of Pittsburgh, Pittsburgh, Pennsylvania, U.S.A.
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  • The authors have no funding, financial relationships, or conflicts of interest to disclose.

Abstract

Objectives/Hypothesis:

To study the cost effectiveness of positron emission tomography-computerized tomography (PET-CT) scanning in the management of the neck after chemoradiotherapy (CRT).

Study Design:

Cost effectiveness and decision analysis model.

Methods:

A cost-effectiveness analysis comparing up-front neck dissection to serial PET-CT imaging in a hypothetical clinical scenario of debate. A patient with an oropharygeal cancer with pretreatment N2 disease having a complete response was considered. Standardized costs were obtained using national databases. A literature review in PubMed was performed to obtain information on incidence, probabilities, and range for various clinical events in the algorithm.

Results:

PET-CT strategy costs an average of $14,492 per patient. Neck dissection had a 0.6% greater efficacy in controlling neck disease with a $22,433 incremental cost.

Conclusions:

Our results strongly support the use of PET-CT imaging as the more cost-effective strategy for surveillance of neck after completion of definitive CRT compared to up-front neck dissection.

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