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A cost‐effectiveness analysis of positron emission tomography‐computed tomography surveillance versus up‐front neck dissection for management of the neck for N2 disease after chemoradiotherapy
Author(s) -
Rabalais Amy,
Walvekar Rohan R.,
Johnson Jonas T.,
Smith Kenneth J.
Publication year - 2012
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.22464
Subject(s) - medicine , positron emission tomography , chemoradiotherapy , radiology , neck dissection , dissection (medical) , tomography , computed tomography , medical physics , nuclear medicine , radiation therapy , cancer
Objectives/Hypothesis: To study the cost effectiveness of positron emission tomography‐computerized tomography (PET‐CT) scanning in the management of the neck after chemoradiotherapy (CRT). Study Design: Cost effectiveness and decision analysis model. Methods: A cost‐effectiveness analysis comparing up‐front neck dissection to serial PET‐CT imaging in a hypothetical clinical scenario of debate. A patient with an oropharygeal cancer with pretreatment N2 disease having a complete response was considered. Standardized costs were obtained using national databases. A literature review in PubMed was performed to obtain information on incidence, probabilities, and range for various clinical events in the algorithm. Results: PET‐CT strategy costs an average of $14,492 per patient. Neck dissection had a 0.6% greater efficacy in controlling neck disease with a $22,433 incremental cost. Conclusions: Our results strongly support the use of PET‐CT imaging as the more cost‐effective strategy for surveillance of neck after completion of definitive CRT compared to up‐front neck dissection.