title: 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.
abstract: OBJECTIVE
  To study the cost effectiveness of positron emission tomography-computerized tomography (PET-CT) scanning in the management of the neck after chemoradiotherapy (CRT).
  
  
  METHODS
  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.
authors.affiliation: Department of Otolaryngology-Head and Neck Surgery, Louisiana State University Health Sciences Center, New Orleans, Louisiana 70112, USA.
authors.forename: Amy
authors.initials: A
authors.lastname: Rabalais
authors.forename: Rohan R
authors.initials: RR
authors.lastname: Walvekar
authors.forename: Jonas T
authors.initials: JT
authors.lastname: Johnson
authors.forename: Kenneth J
authors.initials: KJ
authors.lastname: Smith
mesh_terms: D000970:Antineoplastic Agents / Q000627:therapeutic use*; D002294:Carcinoma, Squamous Cell / Q000000981:diagnostic imaging* / Q000556:secondary / Q000628:therapy; D003362:Cost-Benefit Analysis; D017558:Elective Surgical Procedures / Q000191:economics* / Q000379:methods; D005500:Follow-Up Studies; D006258:Head and Neck Neoplasms / Q000000981:diagnostic imaging* / Q000473:pathology / Q000628:therapy; D006801:Humans; D008207:Lymphatic Metastasis / Q000000981:diagnostic imaging; D064847:Multimodal Imaging / Q000191:economics*; D037981:Neck Dissection / Q000191:economics / Q000379:methods*; D009367:Neoplasm Staging; D049268:Positron-Emission Tomography; D018714:Radiotherapy, Adjuvant; D015203:Reproducibility of Results; D012189:Retrospective Studies; D013997:Time Factors; D014057:Tomography, X-Ray Computed
chemical_list: D000970:Antineoplastic Agents