title: Cost-effectiveness of sentinel lymph node biopsy vs inguinofemoral lymphadenectomy in women with vulval 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.
  
  
  CONCLUSIONS
  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.
authors.affiliation: Health Economics Unit, University of Birmingham, Birmingham, UK.
authors.forename: A J
authors.initials: AJ
authors.lastname: Sutton
authors.forename: P
authors.initials: P
authors.lastname: Barton
authors.forename: S
authors.initials: S
authors.lastname: Sundar
authors.forename: C
authors.initials: C
authors.lastname: Meads
authors.forename: A N
authors.initials: AN
authors.lastname: Rosenthal
authors.forename: P
authors.initials: P
authors.lastname: Baldwin
authors.forename: K
authors.initials: K
authors.lastname: Khan
authors.forename: T E
authors.initials: TE
authors.lastname: Roberts
mesh_terms: D002294:Carcinoma, Squamous Cell / Q000401:mortality / Q000473:pathology*; D003362:Cost-Benefit Analysis; D005260:Female; D017048:Health Care Costs; D006801:Humans; D007264:Inguinal Canal; D008197:Lymph Node Excision / Q000191:economics*; D008198:Lymph Nodes / Q000473:pathology; D008207:Lymphatic Metastasis; D021701:Sentinel Lymph Node Biopsy / Q000191:economics*; D014846:Vulvar Neoplasms / Q000401:mortality / Q000473:pathology*