Publication: A cost-utility analysis comparing standard axillary lymph node dissection with sentinel lymph node biopsy in patients with early stage breast cancer in Thailand
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Issued Date
2014
Resource Type
File Type
application/pdf
ISSN
22121099
Other identifier(s)
2-s2.0-84899816532
Rights Holder(s)
Scopus
Bibliographic Citation
Value in Health Regional Issues. Vol 3, No.1 (2014), p.59-66
Suggested Citation
Songtish D., Praditsitthikorn N., Teerawattananon Y. A cost-utility analysis comparing standard axillary lymph node dissection with sentinel lymph node biopsy in patients with early stage breast cancer in Thailand. Value in Health Regional Issues. Vol 3, No.1 (2014), p.59-66. doi:10.1016/j.vhri.2014.01.003 Retrieved from: https://hdl.handle.net/20.500.14740/6282
Author(s)
Abstract
Objectives: In Thailand, axillary lymph node dissection (ALND) is the dominant form of treatment for breast cancer, even though the treatment often leaves patients with some degree of arm morbidity. Sentinel lymph node biopsy (SNB) is widely accepted globally as a preferable alternative procedure because of its lower rates of associated morbidity. This study compared the cost-utility of SNB and ALND in patients with early stage breast cancer in Thailand. Methods: A decision tree with a 5-year time horizon was developed. Outcomes that were relevant to SNB and ALND were included, along with locoregional recurrence of cancer and lymphedema scenarios. The model parameters were derived from a meta-analysis of international clinical trials and other relevant literature. The resources and cost data were derived from the medical records of tertiary hospitals. Health utilities were measured by using the standard gamble technique. A sensitivity analysis was performed using a set of plausible parameters. Results: The incremental cost-effectiveness ratio (ICER) in the base-case analysis showed that SNB was more cost-effective than ALND. ICERs were -275,140 and -470,600 Thailand baht/quality-adjusted life-year gained from the provider perspective and the societal perspective, respectively. The most sensitive parameter was the utility score of patients with early stage breast cancer who had received breast-conserving therapy with lymphedema; the sensitivity and specificity of SNB had no impact on the ICER. Conclusions: The study confirmed that SNB was an economically viable alternative treatment to ALND. In developing countries, where resources are limited, nationwide implementation of SNB warrants widespread support from relevant stakeholders, including medical personnel and policymakers. © 2014 International Society for Pharmacoeconomics and Outcomes Research (ISPOR).
Subject(s)
Article
Axillary lymph node extirpation
Breast cancer
Cancer recurrence
Cancer staging
Conservative treatment
Cost effectiveness analysis
Cost utility analysis
Early cancer
Health care cost
Human
Intermethod comparison
Lymph node dissection
Lymphedema
Metastasis
Prevalence
Priority journal
Quality adjusted life year
Scoring system
Sensitivity analysis
Sensitivity and specificity
Sentinel lymph node biopsy
Thailand
Axillary lymph node extirpation
Breast cancer
Cancer recurrence
Cancer staging
Conservative treatment
Cost effectiveness analysis
Cost utility analysis
Early cancer
Health care cost
Human
Intermethod comparison
Lymph node dissection
Lymphedema
Metastasis
Prevalence
Priority journal
Quality adjusted life year
Scoring system
Sensitivity analysis
Sensitivity and specificity
Sentinel lymph node biopsy
Thailand