title: Cost-Effectiveness Analysis of Radiation Therapy Versus Transoral Robotic Surgery for Oropharyngeal Squamous Cell Carcinoma.
abstract: The objective of this study was to compare the cost-effectiveness of transoral robotic surgery (TORS) versus the standard treatment modality for oropharyngeal squamous cell carcinoma (OPSCC), radiation therapy (RT), in a subset of patients with early-stage OPSCC.
  
  
  
  We developed a microsimulation state-transition model associated with RT and TORS for patients with clinically staged T1N0M0 to T2N1M0 OPSCC. Transition probabilities, utilities, and costs for each health state were estimated from recently published data and discounted by 3% annually over a lifetime time horizon. Model outcomes included lifetime costs (in 2014 US dollars), health benefits (quality-adjusted life-years [QALYs]), and cost-effectiveness ratios from a societal perspective.
  
  
  
  Under base-case assumptions, TORS was associated with modest gains in QALYs. RT yielded 10.43 QALYs at a cost of $123,410 per patient, whereas TORS yielded 11.10 QALYs at a cost of $178,480. This resulted in an incremental cost-effectiveness ratio of $82,190/QALY gained. The incremental cost-effectiveness ratio was most sensitive to the need for adjuvant therapy, cost of late toxicity, age at diagnosis, disease state utilities, and discount rate. Accounting for joint parameter uncertainty, RT had a higher probability of demonstrating a cost-effective profile compared with TORS, at 54% compared with 46%.
  
  
  
  By use of standard benchmarks for cost-effectiveness in the United States, TORS may be a cost-effective alternative for the subset of patients with early-stage OPSCC but demonstrates considerable sensitivity to assumptions around quality of life.
authors.affiliation: Department of Radiation Oncology, University of Toronto, Toronto, Ontario, Canada.
authors.forename: Danielle
authors.initials: D
authors.lastname: Rodin
authors.affiliation: Department of Otolaryngology-Head and Neck Surgery, University of Ottawa, Ottawa, Ontario, Canada. Electronic address: lcaulley@toh.ca.
authors.forename: Lisa
authors.initials: L
authors.lastname: Caulley
authors.affiliation: Department of Health Policy and Management, Center for Health Decision Science, Harvard T.H. Chan School of Public Health, Boston, Massachusetts.
authors.forename: Emily
authors.initials: E
authors.lastname: Burger
authors.affiliation: Department of Health Policy and Management, Center for Health Decision Science, Harvard T.H. Chan School of Public Health, Boston, Massachusetts.
authors.forename: Jane
authors.initials: J
authors.lastname: Kim
authors.affiliation: Department of Otolaryngology-Head and Neck Surgery, University of Ottawa, Ottawa, Ontario, Canada.
authors.forename: Stephanie
authors.initials: S
authors.lastname: Johnson-Obaseki
authors.affiliation: Department of Radiation Oncology, University of Western Ontario, London, Ontario, Canada.
authors.forename: David
authors.initials: D
authors.lastname: Palma
authors.affiliation: Department of Radiation Oncology, University of Western Ontario, London, Ontario, Canada.
authors.forename: Alexander V
authors.initials: AV
authors.lastname: Louie
authors.affiliation: Department of Medical Oncology, Princess Margaret Cancer Centre, Toronto, Ontario, Canada.
authors.forename: Aaron
authors.initials: A
authors.lastname: Hansen
authors.affiliation: Department of Radiation Oncology, University of Toronto, Toronto, Ontario, Canada; Radiation Medicine Program, Princess Margaret Cancer Centre, Toronto, Ontario, Canada.
authors.forename: Brian
authors.initials: B
authors.lastname: O'Sullivan
mesh_terms: D002294:Carcinoma, Squamous Cell / Q000191:economics* / Q000453:epidemiology / Q000628:therapy*; D003362:Cost-Benefit Analysis / Q000191:economics; D003365:Costs and Cost Analysis / Q000191:economics; D005260:Female; D017048:Health Care Costs / Q000706:statistics & numerical data; D006801:Humans; D038622:Internationality; D008297:Male; D008875:Middle Aged; D018803:Models, Economic; D057605:Natural Orifice Endoscopic Surgery / Q000191:economics* / Q000706:statistics & numerical data; D019647:Oral Surgical Procedures / Q000191:economics / Q000706:statistics & numerical data; D009959:Oropharyngeal Neoplasms / Q000191:economics* / Q000453:epidemiology / Q000628:therapy*; D015995:Prevalence; D020266:Radiotherapy, Conformal / Q000191:economics* / Q000706:statistics & numerical data; D065287:Robotic Surgical Procedures / Q000191:economics* / Q000706:statistics & numerical data; D016896:Treatment Outcome