PharmacoEconomics & Outcomes News | 2021
PET-CT-guided surveillance cost effective for advanced oropharyngeal cancer
Abstract
Positron emission tomography-computed tomography (PET-CT)-guided surveillance with repeat imaging at 6 months for equivocal responders appears to be the most cost-effective approach for managing advanced, nodal human papillomavirus-positive oropharyngeal cancer following chemoradiation in Canada, according to a study published in Cancer. The researchers constructed a Markov model to simulate four management strategies over a lifetime: 1) CT surveillance, 2) standard PET-CT surveillance, 3) novel PET-CT surveillance with repeat PET imaging at 6 months in incomplete/equivocal responders, and 4) post-radiation neck dissection (PRND). Quality-adjusted life years (QALYs) were estimated using data inputs from published literature. Costs (2019 Canadian dollars) were taken from the Princess Margaret Cancer Center and University Health Network, and included those for direct and indirect in-hospital costs such as operating room costs, perioperative care, intensive care unit, nursing, pharmacy, allied healthcare, laboratory tests, and imaging. From a universal payer perspective, PET-CT-guided imaging strategies were dominant (more effective and less costly) compared with CT or PRND. The novel PET-CT-guided surveillance with follow-up PET was the most costeffective strategy, resulting in incremental costs of –$1309 and QALY gains of 0.14 compared with standard PET-CT surveillance. Compared with CT, the novel PET-CT surveillance approach incurred slightly higher costs (+$1067) but yielded more QALYs (+0.43). Probabilistic sensitivity analyses showed that the novel PET-CT surveillance strategy was cost effective in 78% of simulations at a willingness-to-pay threshold of $50 000 per QALY gained.