Cost-Effectiveness Analysis of Chemoradiation Therapy Versus Transoral Robotic Surgery for Human Papillomavirus-Associated, Clinical N2 Oropharyngeal Cancer.

摘要: Purpose To perform a cost-effectiveness analysis of primary chemoradiation therapy (CRT) versus transoral robotic surgery (TORS) for clinical N2, human papillomavirus (HPV)-positive oropharyngeal carcinoma. Methods and Materials We developed Markov model to describe the health states after treatment with CRT or TORS, followed by adjuvant radiation in presence high-risk pathology (positive margins extracapsular extension). Outcomes, toxicities, costs were extracted from literature. One-way sensitivity analyses (SA) performed over wide range parameters, as 2-way SA between key variables. Probabilistic value information studies parameters. Results The expected quality-adjusted life years (QALYs)/total TORS 7.31/$50,100 7.29/$62,200, respectively, so that dominated TORS. In SA, was almost always cost-effective up societal willingness-to-pay $200,000/QALY, unless locoregional recurrence risk 30% 50% lower, at which point it became cost effective $50-100,000/QALY. confirmed importance risk, precisely knowing this parameter more than $7M per year. If long-term utility 0.03 lower CRT, nearly any assumption. Conclusions Under all assumptions, HPV-associated, N2 OPC. However, hypothetical event large relative improvement LRR equivalent utilities, would become higher-value treatment, arguing prospective, comparative study 2 paradigms.