Choi Karen Y, Hao Qiang, Carlisle Kathryn, Hollenbeak Christopher S, Lai Stephen Y
Penn State College of Medicine, Hershey Medical Center, Hershey, PA, USA.
Department of Otolaryngology Head and Neck Surgery, Penn State Hershey Medical Center, Hershey, PA, USA.
Ann Surg Oncol. 2023 Nov;30(12):7689-7698. doi: 10.1245/s10434-023-13937-y. Epub 2023 Aug 9.
Several studies have demonstrated varying rates of efficacy, reliability, and sensitivity of sentinel lymph node biopsy (SLNB) in identifying occult nodal disease for early stage oral cavity squamous cell carcinoma (OCSCC) depending on the radionuclide agent utilized. No head-to-head comparison of cost or clinical outcomes of SLNB when utilizing [Tc]tilmanocept versus [Tc]sulfur colloid has been performed. The goal of this study was to develop a decision model to compare the cost-effectiveness of [Tc]tilmanocept versus [Tc]sulfur colloid in early stage OCSCC.
A decision model of disease and treatment as a function of SLNB was created. Patients with a negative SLNB entered a Markov model of the natural history of OCSCC parameterized with published data to simulate five states of health and iterated over a 30-year time horizon. Treatment costs and quality-adjusted life-years (QALYs) for each health state were included. The incremental cost-effectiveness ratio (ICER) was then estimated using $100,000 per additional QALY as the threshold for determining cost-effectiveness.
The base case cost-effectiveness analysis suggested [Tc]tilmanocept was more effective than [Tc]sulfur colloid by 0.12 QALYs (7.06 versus 6.94 QALYs). [Tc]Tilmanocept was more costly, with a lifetime cost of $84,961 in comparison with $84,264 for sulfur colloid, however, the overall base case ICER was $5859 per additional QALY, well under the threshold for cost-effectiveness. Multiple one-way sensitivity analyses were performed, and demonstrated the model was robust to alternative parameter values.
Our analysis showed that while [Tc]tilmanocept is more costly upfront, these costs are worth the additional QALYs gained by the use of [Tc]tilmanocept.
多项研究表明，根据所使用的放射性核素试剂不同，前哨淋巴结活检（SLNB）在识别早期口腔鳞状细胞癌（OCSCC）隐匿性淋巴结疾病方面的疗效、可靠性和敏感性各不相同。尚未对使用[锝]替莫西肽与[锝]硫胶体进行SLNB的成本或临床结果进行直接比较。本研究的目的是建立一个决策模型，以比较[锝]替莫西肽与[锝]硫胶体在早期OCSCC中的成本效益。
建立了一个将疾病和治疗作为SLNB函数的决策模型。前哨淋巴结活检阴性的患者进入一个根据已发表数据进行参数化的OCSCC自然史马尔可夫模型，以模拟五种健康状态，并在30年的时间范围内进行迭代。纳入了每种健康状态的治疗成本和质量调整生命年（QALY）。然后使用每增加一个QALY 100,000美元作为确定成本效益的阈值来估计增量成本效益比（ICER）。
基础病例成本效益分析表明，[锝]替莫西肽比[锝]硫胶体更有效，多0.12个QALY（分别为7.06和6.94个QALY）。[锝]替莫西肽成本更高，终身成本为84,961美元，而硫胶体为84,264美元，然而，总体基础病例ICER为每增加一个QALY 5859美元，远低于成本效益阈值。进行了多项单向敏感性分析，结果表明该模型对替代参数值具有稳健性。
我们的分析表明，虽然[锝]替莫西肽前期成本更高，但这些成本值得通过使用[锝]替莫西肽获得额外的QALY。
