title: Cost-effectiveness of transoral robotic surgery versus (chemo)radiotherapy for early T classification oropharyngeal carcinoma: A cost-utility analysis.
abstract: BACKGROUND
  The present study is an economic evaluation comparing transoral robotic surgery (TORS) to (chemo)radiotherapy for the management of early T-classification oropharyngeal cancer.
  
  
  METHODS
  A societal perspective was adopted. Treatment for TORS and (chemo)radiotherapy were modeled using decision analysis and recurrences were modeled over a 10 year horizon with a Markov model. Model parameters were derived from systematic review. Deterministic and probabilistic sensitivity analyses were used to test model robustness.
  
  
  RESULTS
  TORS demonstrated a cost savings of $1366 and an increase of 0.25 quality-adjusted life years (QALYs) per case in comparison to (chemo)radiotherapy. TORS was sensitive to variations in adjuvant therapy, costs, utilities, complications, and recurrence rates in deterministic and probabilistic sensitivity analysis. In two-way sensitivity analysis, with increasing adjuvant therapy for TORS and decreasing concurrent chemotherapy for radiotherapy, TORS is decreasingly cost-effective.
  
  
  CONCLUSIONS
  TORS is cost-effective for treatment of early oropharyngeal cancer. Case selection to minimize adjuvant therapy ensures cost-effective treatment.
authors.affiliation: Department of Otolaryngology-Head and Neck Surgery, Princess Margaret Hospital, Toronto, Canada.
authors.forename: John R
authors.initials: JR
authors.lastname: de Almeida
authors.affiliation: Departments of Health Evidence & Policy and Medicine, Icahn School of Medicine at Mount Sinai, New York, New York.
authors.forename: Alan J
authors.initials: AJ
authors.lastname: Moskowitz
authors.affiliation: Department of Otolaryngology-Head and Neck Surgery, Icahn School of Medicine at Mount Sinai, New York, New York.
authors.forename: Brett A
authors.initials: BA
authors.lastname: Miles
authors.affiliation: Department of Otolaryngology-Head and Neck Surgery, Princess Margaret Hospital, Toronto, Canada.
authors.forename: David P
authors.initials: DP
authors.lastname: Goldstein
authors.affiliation: Department of Otolaryngology-Head and Neck Surgery, Icahn School of Medicine at Mount Sinai, New York, New York.
authors.forename: Marita S
authors.initials: MS
authors.lastname: Teng
authors.affiliation: Department of Otolaryngology-Head and Neck Surgery, Icahn School of Medicine at Mount Sinai, New York, New York.
authors.forename: Andrew G
authors.initials: AG
authors.lastname: Sikora
authors.affiliation: Department of Radiation Oncology, Icahn School of Medicine at Mount Sinai, New York, New York.
authors.forename: Vishal
authors.initials: V
authors.lastname: Gupta
authors.affiliation: Department of Medical Oncology, Icahn School of Medicine at Mount Sinai, New York, New York.
authors.forename: Marshall
authors.initials: M
authors.lastname: Posner
authors.affiliation: Department of Otolaryngology-Head and Neck Surgery, Icahn School of Medicine at Mount Sinai, New York, New York.
authors.forename: Eric M
authors.initials: EM
authors.lastname: Genden
mesh_terms: D059248:Chemoradiotherapy / Q000009:adverse effects / Q000191:economics*; D003131:Combined Modality Therapy / Q000191:economics; D003362:Cost-Benefit Analysis; D003661:Decision Support Techniques; D017048:Health Care Costs / Q000706:statistics & numerical data*; D006801:Humans; D009364:Neoplasm Recurrence, Local; D009367:Neoplasm Staging; D009959:Oropharyngeal Neoplasms / Q000191:economics* / Q000628:therapy; D065287:Robotic Surgical Procedures / Q000009:adverse effects / Q000191:economics*
keywords: chemotherapy; cost-utility; dominant; radiotherapy; transoral robotic surgery (TORS)