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What treatment for early‐stage glottic carcinoma among adult patients: CO 2 endolaryngeal laser excision versus standard fractionated external beam radiation is superior in terms of cost utility?
Author(s) -
Higgins Kevin M.
Publication year - 2011
Publication title -
the laryngoscope
Language(s) - English
Resource type - Journals
SCImago Journal Rank - 1.181
H-Index - 148
eISSN - 1531-4995
pISSN - 0023-852X
DOI - 10.1002/lary.21226
Subject(s) - medicine , confidence interval , laryngectomy , odds ratio , surgery , larynx
Objectives/Hypothesis: To determine which treatment for Tis/T1 glottic carcinoma among adult patients, transoral CO 2 laser excision (TOL) versus external beam radiation (XRT), is superior in terms of cost utility. Study Design: Cost‐utility analysis. Methods: Six head‐to‐head comparison studies and 22 consecutive case series were identified to examine oncologic control. The case series were pooled as a composite group. Primary end points were local control (LC), laryngectomy‐free survival (LFS), and overall survival (OS). Objective and subjective voice‐quality measures were secondary end points. Third‐party payer perspective was adopted for cost‐utility analysis. Operational and capital costs were determined with the microcosting method. Rollback calculations and quality adjusted life years (QALYs) were calculated with decision‐tree modeling. Results: There were no significant differences between TOL surgery and XRT with respect to LC (odds ratio [OR], 0.81; 95% confidence interval [CI], 0.51‐1.3) and LFS (OR, 0.84, 95% CI, 0.42‐1.66). The weighted mean difference for OS was 0.03. There were no objective differences for measures of voice quality. Decision‐tree analysis was undertaken using mean 5‐year local control initial probabilities. CO 2 laser cost $2475.65/case (US $2407.32/case), generating 1.663 QALYs, whereas radiation cost $4965.85/case (US $4828.79/case), generating 1.506 QALYs. This contrasts initial upstream costs for CO 2 laser (∼$1889/case, ∼US $1836.86/case) and radiation (∼$2454.70/case, ∼US $2386.95/case). Conclusions: This meta‐analysis shows that there is no clear difference in oncologic outcome between TOL surgery and XRT. There is a trend for improved post‐treatment voice quality with XRT, although the clinical significance of this is questionable. TOL surgery dominates XRT from a cost‐utility standpoint primarily because of the enhanced downstream affordability of salvage treatment. Laryngoscope, 2011