title: Cost-utility of sentinel lymph node biopsy in cT1-T2N0 oral cancer.
abstract: OBJECTIVE
  To calculate the cost-utility of different strategies for the detection of occult lymph node metastases in cT1-T2N0 oral cancer.
  
  
  METHODS
  A decision tree followed by a Markov model was designed to compare the cost-utility of the following strategies: (a) USgFNAC (ultrasound guided fine needle aspiration cytology), (b) SLNB (sentinel lymph node biopsy), (c) USgFNAC and, if negative, SLNB (d) END (elective neck dissection). Data was collected from 62 patients in four Dutch head and neck centres. Utilities were measured with the EQ5D questionnaire and resource use was recorded from patient charts. Costs were calculated from a hospital perspective. Uncertainty was explored with scenario analyses and probabilistic sensitivity analyses.
  
  
  RESULTS
  With a 5- or 10-year time horizon, SLNB results in the highest number of additional quality-adjusted life years (QALYs, 0.12 and 0.26, respectively) for the smallest additional costs (€56 and €74, respectively) compared to USgFNAC. With a lifetime horizon END results in the highest number of additional QALYs (0.55) for an additional €1.626 per QALY gained compared to USgFNAC. When we make different assumptions regarding the duration of disutilities (⩾5 years) or the improvement (⩾3%) of sensitivity of SLNB, SLNB is the most favourable strategy from all time horizons.
  
  
  CONCLUSIONS
  SLNB is a good diagnostic strategy to evaluate cT1-T2N0 oral cancer. SLNB is the preferred strategy in a 5- or 10-year time horizon. From a lifetime horizon, END may be preferred. SLNB may become the optimal strategy from all time horizons if its sensitivity can be slightly improved.
authors.affiliation: Institute for Medical Technology Assessment, Erasmus University Rotterdam, PO Box 1738, 3000 DR Rotterdam, The Netherlands; CHERE, University of Technology Sydney, PO Box 123, Broadway NSW 2007, Sydney, Australia. Electronic address: naomi.vanderlinden@chere.uts.edu.au.
authors.forename: Naomi
authors.initials: N
authors.lastname: van der Linden
authors.affiliation: Department of Otolaryngology-Head and Neck Surgery, VU University Medical Center, PO Box 7057, 1007 MB Amsterdam, The Netherlands. Electronic address: gb.flach@vumc.nl.
authors.forename: Géke B
authors.initials: GB
authors.lastname: Flach
authors.affiliation: Department of Otolaryngology-Head and Neck Surgery, VU University Medical Center, PO Box 7057, 1007 MB Amsterdam, The Netherlands; Department of Head and Neck Surgical Oncology, UMC Utrecht Cancer Center, UMC Utrecht, PO Box 85500, 3508 GA Utrecht, The Netherlands. Electronic address: R.deBree@umcutrecht.nl.
authors.forename: Remco
authors.initials: R
authors.lastname: de Bree
authors.affiliation: Institute for Medical Technology Assessment, Erasmus University Rotterdam, PO Box 1738, 3000 DR Rotterdam, The Netherlands. Electronic address: uyl@bmg.eur.nl.
authors.forename: Carin A
authors.initials: CA
authors.lastname: Uyl-de Groot
mesh_terms: D003362:Cost-Benefit Analysis; D061765:Endoscopic Ultrasound-Guided Fine Needle Aspiration / Q000191:economics*; D006801:Humans; D008198:Lymph Nodes / Q000473:pathology*; D008207:Lymphatic Metastasis / Q000473:pathology*; D009062:Mouth Neoplasms / Q000191:economics / Q000473:pathology*; D009333:Neck; D037981:Neck Dissection / Q000191:economics*; D009426:Netherlands; D019057:Quality-Adjusted Life Years; D021701:Sentinel Lymph Node Biopsy / Q000191:economics*; D011795:Surveys and Questionnaires
keywords: Cost–benefit analysis; Decision support techniques; Decision trees; Fine-needle biopsy; Markov chains; Mouth neoplasms; Neck dissection; Quality-adjusted life years; Sentinel lymph node biopsy