Transoral laser microsurgery versus radiation therapy in the management of T1 and T2 laryngeal glottic carcinoma: which modality is cost-effective within the UK?

Abstract

Objectives

To identify the most cost effective treatment strategy in patients with early stage (T1and T2) cancers of the laryngeal glottis.

Design

A Markov decision model populated using data from updated systematic reviews and meta analyses, with attributable costs from NHS sources. Data on local control and mortality was obtained from updates of existing systematic reviews conducted for the NICE guideline on cancer of the upper aerodigestive tract. Procedure costs were sourced from NHS reference costs 2013/14 by applying tariffs associated with the appropriate health resource group code.

Setting

The UK National Health Service.

Population

Patients with early stage (T1 and T2) cancers of the laryngeal glottis.

Interventions

Transoral laser microsurgery (TLM) and radiation therapy (RT).

Main outcome measures

Total costs, incremental costs and quality adjusted life years (QALYs) over a ten-year time horizon.

Results

RT as the initial treatment strategy was found to be more expensive (£2,654 vs £623) and less effective (QALY reduction of 0.141 and 0.04 in T1a and T1b-T2 laryngeal cancer respectively) than TLM. The dominance of TLM for T1a cancers was unchanged in most scenarios modelled in sensitivity analysis. For T1b-T2 laryngeal cancers, the result changed in numerous scenarios. In probabilistic sensitivity analysis, TLM was found to have a 71% and 58% probability of being cost-effective in T1a and T1b-T2 laryngeal cancer, respectively.

Conclusions

TLM is a cost effective strategy to adopt in the management of T1a laryngeal cancers. Uncertainty remains over the optimal strategy to adopt in T1b-T2 laryngeal cancers.

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