Journal
BRITISH JOURNAL OF CANCER
Volume 109, Issue 10, Pages 2533-2547Publisher
NATURE PUBLISHING GROUP
DOI: 10.1038/bjc.2013.631
Keywords
vulvar cancer; cost-effectiveness; sentinel lymph node biopsy; inguinofemoral lymphadenectomy
Categories
Funding
- Health Technology Assessment
- National Institute of Health Research, United Kingdom [09/112/03]
- MRC [G0800808] Funding Source: UKRI
- Medical Research Council [G0800808] Funding Source: researchfish
- National Institute for Health Research [09/112/03] Funding Source: researchfish
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Background: This study examines the cost-effectiveness of sentinel lymph node biopsy, a potentially less morbid procedure, compared with inguinofemoral lymphadenectomy (IFL) among women with stage I and stage II vulval squamous cell carcinoma. Methods: A model-based economic evaluation was undertaken based on clinical evidence from a systematic review of published sources. A decision tree model was developed with the structure being informed by clinical input, taking the perspective of the health-care provider. Results: For overall survival for 2 years, IFL was found to be the most cost-effective option and dominated all other strategies, being the least costly and most effective. For morbidity-free related outcomes for 2 years, sentinel lymph node (SLN) biopsy with 99mTc and blue dye and haematoxylin &eosin (H&E) histopathology, with ultrastaging and immunohistochemistry reserved for those that test negative following H&E is likely to be the most effective approach. Conclusion: SLN biopsy using 99mTc and blue dye with ultrastaging may be considered the most cost-effective strategy based on the outcome of survival free of morbidity for 2 years. The findings here also indicate that using blue dye and H&E for the identification of the SLN and the identification of metastasis, respectively, are not sensitive enough to be used on their own.
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