title: Lymphatic mapping and sentinel lymph node dissection compared to complete lymphadenectomy in the management of early-stage vulvar cancer: A cost-utility analysis.
abstract: OBJECTIVE
  Sentinel lymph node biopsy (SLNB) is an acceptable method of evaluating groin lymph nodes in women with vulvar cancer. The purpose of this study is to assess the cost and effectiveness of SLNB compared to universal inguinofemoral lymphadenectomy (LND) for vulvar cancer.
  
  
  METHODS
  A modified Markov decision model was generated to compare two surgical approaches for newly diagnosed, early-stage vulvar cancer: (1) radical vulvectomy+LND and (2) radical vulvectomy+SLNB. Published data were used to estimate survival outcomes, probability of positive lymph nodes and lymphedema. Costs of surgery and radiation and lymphedema therapies were estimated from published data. Lymphedema's effect on quality of life (QOL) was extrapolated from other disease sites and assigned a utility score of 0.84. Multiple sensitivity analyses were performed.
  
  
  RESULTS
  SLNB was less costly ($13,449 versus $14,261) and more effective (4.16 quality-adjusted life years (QALYs) versus 4.00 QALYs) than LND. The model was sensitive to the impact of lymphedema on QOL. Unless the impact of lymphedema on QOL was minimal (utility score>0.975) SLNB dominated LND. Variations in the rate of positive SLNB and probability of lymphedema over clinically reasonable ranges did not alter the results.
  
  
  CONCLUSIONS
  SLNB is a cost-effective strategy for the treatment of newly diagnosed vulvar cancer, mainly due to the impact of lymphedema on QOL.
authors.affiliation: Department of Obstetrics and Gynecology, Division of Gynecologic Oncology, University of Texas Health Science Center at San Antonio, United States. Electronic address: mccanng@uthscsa.edu.
authors.forename: Georgia A
authors.initials: GA
authors.lastname: McCann
authors.affiliation: Department of Obstetrics and Gynecology, Division of Gynecologic Oncology, The Ohio State University Comprehensive Cancer Center - Arthur G. James Cancer Hospital and Richard J. Solve Research Institute, United States.
authors.forename: David E
authors.initials: DE
authors.lastname: Cohn
authors.affiliation: Department of Surgery, Gynecology Service, Memorial Sloan-Kettering Cancer Center, United States.
authors.forename: Elizabeth L
authors.initials: EL
authors.lastname: Jewell
authors.affiliation: Department of Obstetrics and Gynecology, Division of Gynecologic Oncology, Duke University, United States.
authors.forename: Laura J
authors.initials: LJ
authors.lastname: Havrilesky
mesh_terms: D003362:Cost-Benefit Analysis / Q000379:methods; D003661:Decision Support Techniques; D005260:Female; D006801:Humans; D008197:Lymph Node Excision / Q000191:economics* / Q000379:methods*; D008198:Lymph Nodes / Q000473:pathology / Q000601:surgery*; D008207:Lymphatic Metastasis; D008390:Markov Chains; D018803:Models, Economic; D009367:Neoplasm Staging; D011788:Quality of Life; D021701:Sentinel Lymph Node Biopsy / Q000191:economics* / Q000379:methods*; D014481:United States; D014846:Vulvar Neoplasms / Q000191:economics* / Q000473:pathology / Q000601:surgery*
keywords: Cost-utility analysis; Lymphedema; Sentinel lymph node biopsy; Vulvar cancer