OBJECTIVE: The objective of this study was to determine the costs and outcomes of inguinal-femoral lymph node dissection (IF-LND) versus sentinel lymph node biopsy (SLNB) for the management of early-stage vulvar cancer. METHODS: A cost-effectiveness model compared 2 different strategies for the management of early-stage vulvar cancer: (1) vulvectomy and SLNB and (2) vulvectomy and IF-LND. Probabilities of inguinal-femoral node metastases and recurrence rates associated with each strategy were estimated from published data. Actual payer costs of surgery and radiation therapy were obtained using 2012 CPT codes and Medicare payment information. Rates and costs of postoperative complications including lymphedema, lymphocyst formation, and infection were estimated and included in a separate model. Cost-effectiveness ratios were determined for each strategy. Sensitivity analyses were performed to evaluate pertinent uncertainties in the models. RESULTS: For the estimated 3000 women diagnosed annually with early-stage vulvar cancer in the United States, the annual cost of the SLNB strategy is $65.2 million compared with $76.8 million for the IF-LND strategy. Three-year inguinal-femoral recurrence-free survival was similar between groups (96.9% vs 97.3%). This translates into a lower cost-effectiveness ratio for the SLNB strategy ($22,416), compared with the IF-LND strategy ($26,344). When adding complication costs to the model, cost-effectiveness ratios further favor the SLNB strategy ($23,711 vs $31,198). Sensitivity analysis revealed that the SLNB strategy remained cost-effective until the recurrence rate after a negative sentinel lymph node approaches 9%. CONCLUSIONS: Sentinel lymph node biopsy is the most cost-effective strategy for the management of patients with early-stage vulvar cancer due to lower treatment costs and lower costs due to complications.
OBJECTIVE: The objective of this study was to determine the costs and outcomes of inguinal-femoral lymph node dissection (IF-LND) versus sentinel lymph node biopsy (SLNB) for the management of early-stage vulvar cancer. METHODS: A cost-effectiveness model compared 2 different strategies for the management of early-stage vulvar cancer: (1) vulvectomy and SLNB and (2) vulvectomy and IF-LND. Probabilities of inguinal-femoral node metastases and recurrence rates associated with each strategy were estimated from published data. Actual payer costs of surgery and radiation therapy were obtained using 2012 CPT codes and Medicare payment information. Rates and costs of postoperative complications including lymphedema, lymphocyst formation, and infection were estimated and included in a separate model. Cost-effectiveness ratios were determined for each strategy. Sensitivity analyses were performed to evaluate pertinent uncertainties in the models. RESULTS: For the estimated 3000 women diagnosed annually with early-stage vulvar cancer in the United States, the annual cost of the SLNB strategy is $65.2 million compared with $76.8 million for the IF-LND strategy. Three-year inguinal-femoral recurrence-free survival was similar between groups (96.9% vs 97.3%). This translates into a lower cost-effectiveness ratio for the SLNB strategy ($22,416), compared with the IF-LND strategy ($26,344). When adding complication costs to the model, cost-effectiveness ratios further favor the SLNB strategy ($23,711 vs $31,198). Sensitivity analysis revealed that the SLNB strategy remained cost-effective until the recurrence rate after a negative sentinel lymph node approaches 9%. CONCLUSIONS: Sentinel lymph node biopsy is the most cost-effective strategy for the management of patients with early-stage vulvar cancer due to lower treatment costs and lower costs due to complications.
Authors: Maaike H Oonk; Bettien M van Hemel; Harry Hollema; Joanne A de Hullu; Anca C Ansink; Ignace Vergote; René H Verheijen; Angelo Maggioni; Katja N Gaarenstroom; Peter J Baldwin; Eleonora B van Dorst; Jacobus van der Velden; Ralph H Hermans; Hans W van der Putten; Pierre Drouin; Ingo B Runnebaum; Wim J Sluiter; Ate G van der Zee Journal: Lancet Oncol Date: 2010-05-25 Impact factor: 41.316
Authors: Tyler O Kirby; Rodney P Rocconi; T Michael Numnum; James E Kendrick; Jason Wright; Wiley Fowler; David G Mutch; Snehal M Bhoola; Warner K Huh; J Michael Straughn Journal: Gynecol Oncol Date: 2005-08 Impact factor: 5.482
Authors: K M McMasters; S L Wong; C Chao; C Woo; T M Tuttle; R D Noyes; D J Carlson; A L Laidley; T Q McGlothin; P B Ley; C M Brown; R L Glaser; R E Pennington; P S Turk; D Simpson; M J Edwards Journal: Ann Surg Date: 2001-09 Impact factor: 12.969
Authors: Christopher P DeSimone; Jennifer S Van Ness; Amy L Cooper; Susan C Modesitt; Paul D DePriest; Frederick R Ueland; Edward J Pavlik; Richard J Kryscio; John R van Nagell Journal: Gynecol Oncol Date: 2006-10-05 Impact factor: 5.482
Authors: Jay W Carlson; James Kauderer; Joan L Walker; Michael A Gold; David O'Malley; Erin Tuller; Daniel L Clarke-Pearson Journal: Gynecol Oncol Date: 2008-05-15 Impact factor: 5.482
Authors: F Hinten; L C G van den Einden; J C M Hendriks; A G J van der Zee; J Bulten; L F A G Massuger; H P van de Nieuwenhof; J A de Hullu Journal: Br J Cancer Date: 2011-10-04 Impact factor: 7.640
Authors: Stephanie Cham; Ling Chen; William M Burke; June Y Hou; Ana I Tergas; Jim C Hu; Cande V Ananth; Alfred I Neugut; Dawn L Hershman; Jason D Wright Journal: Obstet Gynecol Date: 2016-10 Impact factor: 7.661
Authors: Floris P R Verbeek; Quirijn R J G Tummers; Daphne D D Rietbergen; Alexander A W Peters; Boudewijn E Schaafsma; Cornelis J H van de Velde; John V Frangioni; Fijs W B van Leeuwen; Katja N Gaarenstroom; Alexander L Vahrmeijer Journal: Int J Gynecol Cancer Date: 2015-07 Impact factor: 3.437