Cost‐Effectiveness Analysis of PET‐CT Surveillance After Treatment of Human Papillomavirus‐Positive Oropharyngeal Cancer
Matthew E. Lin, Carlos X. Castellanos, Joseph R. Acevedo, Jeffrey C. Yu, Niels C. Kokot- Otorhinolaryngology
- Surgery
Abstract
Objective
To determine the cost‐effectiveness of surveillance imaging with PET/CT scan among patients with human papillomavirus‐positive oropharyngeal squamous cell carcinoma.
Study Design
Cost‐effectiveness analysis.
Setting
Oncologic care centers in the United States with head and neck oncologic surgeons and physicians.
Methods
We compared the cost‐effectiveness of 2 posttreatment surveillance strategies: clinical surveillance with the addition of PET/CT scan versus clinical surveillance alone in human papillomavirus‐positive oropharyngeal squamous cell carcinoma patients. We constructed a Markov decision model which was analyzed from a third‐party payer's perspective using 1‐year Markov cycles and a 30‐year time horizon. Values for transition probabilities, costs, health care utilities, and their studied ranges were derived from the literature.
Results
The incremental cost‐effectiveness ratio for PET/CT with clinical surveillance versus clinical surveillance alone was $89,850 per quality‐adjusted life year gained. Flexible fiberoptic scope exams during clinical surveillance would have to be over 51% sensitive or PET/CT scan cost would have to exceed $1678 for clinical surveillance alone to be more cost‐effective. The willingness‐to‐pay threshold at which imaging surveillance was equally cost‐effective to clinical surveillance was approximately $80,000/QALY.
Conclusion
Despite lower recurrence rates of human papillomavirus‐positive oropharyngeal cancer, a single PET/CT scan within 6 months after primary treatment remains a cost‐effective tool for routine surveillance when its cost does not exceed $1678. The cost‐effectiveness of this strategy is also dependent on the clinical surveillance sensitivity (flexible fiberoptic pharyngoscopy), and willingness‐to‐pay thresholds which vary by country.