INTRODUCTION: Several studies have demonstrated cost savings for patients who undergo sentinel lymph node biopsy (SLNB) for early-stage oral cavity cancer (OCC) compared to elective neck dissection (END). Outcomes with efficacy, reliability, and sensitivity of SLNB in identifying occult nodal disease vary depending on the radionuclide agent utilized. No head-to-head comparison of cost or clinical outcomes of SLNB when utilizing tilmanocept vs. sulfur colloid has been performed. The goal of this study was to develop a decision model to compare the costeffectiveness of tilmanocept vs. sulfur colloid in early-stage OCC.
MATERIALS AND METHODS: A decision model, including a decision tree and Markov model, of disease and treatment as a function of SLNB in OCC was created. Groups were separated by radionuclide agent used. The Markov model was parameterized using data from relevant literature to simulate five states of health (no evidence of disease, local recurrence, nodal recurrence, distant metastasis, and death). Treatment costs and quality-adjusted life years (QALY) for each health state were included in the model. The incremental cost-effectiveness ratio (ICER) was estimated using $100,000 per additional QALY as the threshold for determining cost-effectiveness.
RESULTS: The analysis suggested tilmanocept was more effective than sulfur colloid by 0.12 QALYs, although more costly, with a lifetime cost of $85,208 (vs. $84,264 for sulfur colloid.) However, overall base case ICER was $7,933 per additional QALY, well under the threshold cost. Sensitivity analyses performed to assess the sensitivity of the models to diagnostic performance characteristics of the agents suggested the model was robust to alternative parameter values, and most sensitive to the relative sensitivity and specificity of tilmanocept and sulfur colloid.
CONCLUSION: Our analysis of cost-effectiveness of tilmanocept vs. sulfur colloid showed that while tilmanocept is more costly upfront, these costs are worth the additional QALYs gained by the use of tilmanocept.
