Sentinel Lymph-Node Biopsy Guided Neck Dissection Versus Elective Neck Dissection in the Management of Early-Stage Oral Cancer-A Cost-Utility Analysis.

OBJECTIVES

This study aims to assess the incremental cost per quality-adjusted-life-year (QALY) gained in treating patients with early oral squamous cell carcinoma (OSCC) using sentinel lymph node biopsy (SLNB) guided neck dissection.

METHODS

A Markov model was created to simulate disease-free survival, recurrence, and overall survival in a hypothetical cohort of patients with early OSCC in India. Three groups were assessed: Group I-SLNB-guided neck dissection, Group II-elective neck dissection (END) alone, and Group III-END with frozen section (FS). Costs and QALY were assessed using a payer's perspective, lifetime horizon, and 3% discount, and incremental cost utility ratios (ICUR) were computed. Interventions with ICUR less than one-time gross domestic product (GDP) per capita were considered cost-effective. Both one-way and probabilistic-sensitivity analyses were conducted to examine model uncertainty.

RESULTS

In comparison to Group II and Group III, Group I incurs additional costs of INR 5564 (US$ 67) and INR 2507 (US$ 30) per patient, respectively, and results in an incremental gain of 0.31 and 0.33 additional QALYs, respectively, over a lifetime horizon. The ICURs for Group I versus Group II and Group III are INR 8088 (US$ 97) and INR 16,709 (US$ 200), respectively. At a threshold of one-time per-capita GDP, SLNB demonstrates a 94% probability of being cost-effective.

CONCLUSION

SLNB-guided neck dissection is a cost-effective strategy for management of early OSCC in India. Our findings support inclusion of SLNB-guided neck dissection in the Indian Government's insurance program.