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. 2013 Nov 12;109(10):2533-47.
doi: 10.1038/bjc.2013.631. Epub 2013 Oct 15.

Cost-effectiveness of sentinel lymph node biopsy vs inguinofemoral lymphadenectomy in women with vulval cancer

A J Sutton  1 , P Barton, S Sundar, C Meads, A N Rosenthal, P Baldwin, K Khan, T E Roberts
Affiliations

Cost-effectiveness of sentinel lymph node biopsy vs inguinofemoral lymphadenectomy in women with vulval cancer

A J Sutton et al. Br J Cancer. .

Abstract

Background: This study examines the cost-effectiveness of sentinel lymph node biopsy, a potentially less morbid procedure, compared with inguinofemoral lymphadenectomy (IFL) among women with stage I and stage II vulval squamous cell carcinoma.

Methods: A model-based economic evaluation was undertaken based on clinical evidence from a systematic review of published sources. A decision tree model was developed with the structure being informed by clinical input, taking the perspective of the health-care provider.

Results: For overall survival for 2 years, IFL was found to be the most cost-effective option and dominated all other strategies, being the least costly and most effective. For morbidity-free related outcomes for 2 years, sentinel lymph node (SLN) biopsy with 99mTc and blue dye and haematoxylin & eosin (H&E) histopathology, with ultrastaging and immunohistochemistry reserved for those that test negative following H&E is likely to be the most effective approach.

Conclusion: SLN biopsy using 99mTc and blue dye with ultrastaging may be considered the most cost-effective strategy based on the outcome of survival free of morbidity for 2 years. The findings here also indicate that using blue dye and H&E for the identification of the SLN and the identification of metastasis, respectively, are not sensitive enough to be used on their own.

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Figures

Figure 1
Figure 1
Summary of the decision pathway used in the economic model.
Figure 2
Figure 2
Model structure showing each of the seven primary treatment pathways, and the subsequent treatment pathway for blue dye+H&E. This is repeated for each of the pathways that include either blue dye and/or 99mTc.
Figure 3
Figure 3
Cost-effectiveness acceptability frontier showing the results of the probabilistic sensitivity analysis examining the optimal treatment strategy across a range of willingness to pay thresholds for the outcome of additional case of survival free of morbidity for 2 years.
Figure A1
Figure A1
Treatment pathway following an IFL.
Figure A2
Figure A2
Treatment pathway for strategies 2–6 following a true-positive result for metastasis.
Figure A3
Figure A3
Treatment pathway for strategies 2–6 following a false-negative result for metastasis.
Figure A4
Figure A4
Treatment pathway for strategies 2–6 following a true-negative result for metastasis.
Figure A5
Figure A5
Scatterplot showing the uncertainty in costs and effectiveness within the model for each of the seven strategies for 1000 runs with overall survival for 2 years as the outcome measure
Figure A6
Figure A6
Scatterplot showing the uncertainty in costs and effectiveness for each of the seven strategies for 1000 runs with survival free of morbidity as the outcome measure
Figure A7
Figure A7
Scatterplot showing the uncertainty in costs and effectiveness within the model for each of the 7 strategies for 1000 runs with survival free of long-term morbidity for 2 years as the outcome measure
Figure A8
Figure A8
Cost-effectiveness acceptability frontier showing the results of the sensitivity analysis examining the optimal investigative strategy across a range of willingness to pay thresholds for the outcome of additional case of survival free of long-term morbidity
See this image and copyright information in PMC

References

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