title: Cost-effectiveness of selective neck dissection versus modified radical neck dissection for treating metastases in patients with oral cavity cancer: A modelling study.
abstract: BACKGROUND
  Choosing between a more or less extensive neck dissection implies a tradeoff between survival, quality of life, and costs. The purpose of this study was to determine if selective neck dissection (level I-III or I-IV) is cost-effective compared with modified radical neck dissection (level I-V) in patients with cT1-2 oral squamous cell carcinoma (OSCC) with singular nodal disease confined to level I or II.
  
  
  METHODS
  A decision-analytic model was developed to model quality-adjusted life years (QALYs) and costs over a lifetime horizon, based on literature.
  
  
  RESULTS
  The selective neck dissection strategy resulted in an expected health loss of 0.06 QALY and savings of €1351 per patient compared to modified radical neck dissection. The results were sensitive to differences in regional failure probabilities between the strategies.
  
  
  CONCLUSIONS
  With the evidence used in this model, selective neck dissection was not cost-effective compared to modified radical neck dissection. Prospective research on regional failure is needed to provide optimal treatment for patients with OSCC.
authors.affiliation: Department of Operating Rooms, Radboud University Medical Center, Nijmegen, The Netherlands.
authors.forename: Tim M
authors.initials: TM
authors.lastname: Govers
authors.affiliation: Department of Operating Rooms, Radboud University Medical Center, Nijmegen, The Netherlands.
authors.forename: Sejal
authors.initials: S
authors.lastname: Patel
authors.affiliation: Department of Otorhinolaryngology and Head and Neck Surgery, Radboud University Medical Center, Nijmegen, The Netherlands.
authors.forename: Robert P
authors.initials: RP
authors.lastname: Takes
authors.affiliation: Department of Oral and Maxillofacial Surgery, Radboud University Medical Center, Nijmegen, The Netherlands.
authors.forename: Thijs
authors.initials: T
authors.lastname: Merkx
authors.affiliation: Department of Operating Rooms, Radboud University Medical Center, Nijmegen, The Netherlands.|Department for Health Evidence, Radboud University Medical Center, Nijmegen, The Netherlands.
authors.forename: Maroeska
authors.initials: M
authors.lastname: Rovers
authors.affiliation: Department of Operating Rooms, Radboud University Medical Center, Nijmegen, The Netherlands.|Department for Health Evidence, Radboud University Medical Center, Nijmegen, The Netherlands.
authors.forename: Janneke
authors.initials: J
authors.lastname: Grutters
mesh_terms: D002294:Carcinoma, Squamous Cell / Q000191:economics* / Q000401:mortality / Q000556:secondary / Q000601:surgery; D003362:Cost-Benefit Analysis; D006801:Humans; D008390:Markov Chains; D009062:Mouth Neoplasms / Q000191:economics* / Q000401:mortality / Q000473:pathology / Q000601:surgery; D037981:Neck Dissection / Q000191:economics* / Q000379:methods; D009367:Neoplasm Staging; D009426:Netherlands; D011788:Quality of Life; D016019:Survival Analysis; D016896:Treatment Outcome
keywords: cost effectiveness; decision support techniques; head and neck neoplasms; mouth neoplasms; neck dissection