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Annals of Oncology Advance Access published online on October 15, 2009
Annals of Oncology, doi:10.1093/annonc/mdp405
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© The Author 2009. Published by Oxford University Press on behalf of the European Society for Medical Oncology. All rights reserved. For permissions, please email: journals.permissions@oxfordjournals.org

Cost-effectiveness of CT and PET-CT for determining the need for adjuvant neck dissection in locally advanced head and neck cancer

D. J. Sher1,2,*, R. B. Tishler1, D. Annino3 and R. S. Punglia1,2

1 Department of Radiation Oncology, Dana-Farber Cancer Institute and Brigham and Women’s Hospital, Boston
2 Center for Outcomes and Policy Research, Dana-Farber Cancer Institute, Boston, MA, USA
3 Division of Otolaryngology, Brigham and Women’s Hospital, Boston, MA, USA

* Correspondence to: Dr D. Sher, Department of Radiation Oncology, Dana-Farber Cancer Institute and Brigham and Women's Hospital, 44 Binney Street, Boston, MA 02115, USA. Tel: +1-617-632-3591; Fax: +1-617-632-4247; E-mail: dsher{at}lroc.harvard.edu

Background: Patients with node-positive head and neck squamous cell carcinomas (HNC) have a significant risk of residual disease (RD) in the neck after treatment, despite optimal chemoradiotherapy (CRT). Adjuvant neck dissection (ND) after CRT has been considered standard treatment, but its morbidity has led investigators to consider using post-CRT imaging to determine the need for surgery. We analyzed the cost-effectiveness of computed tomography (CT) and positron emission tomography–computed tomography (PET-CT) as predictors of the need for ND compared with ND for all patients.

Materials and methods: We developed a Markov model to describe health states in the 5 years after CRT for HNC in a 50-year-old man. We compared three strategies: dissect all patients, dissect patients with RD on CT, and dissect patients with RD on PET-CT. Probabilistic sensitivity analyses were carried out to model uncertainty in PET-CT performance, up-front and salvage dissection costs, and patient utilities.

Results: ND only for patients with RD on PET-CT was the dominant strategy over a wide range of realistic and exaggerated assumptions. Probabilistic sensitivity analyses confirmed that the PET-CT strategy was almost certainly cost-effective at a societal willingness-to-pay threshold of $500 000/quality-adjusted life year.

Conclusion: Adjuvant ND reserved for patients with RD on PET-CT is the dominant and cost-effective strategy.

cost-effectiveness analysis, neck dissection, radiotheraphy, PET-CT

Received for publication March 20, 2009. Accepted for publication July 14, 2009.


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