A cost-effectiveness analysis of three approaches for lymph node assessment in patients with low- and intermediate-risk endometrial cancer

Lara C. Burg*, Robin J. Vermeulen, Ruud L. M. Bekkers, Stan R. W. Wijn, Maroeska M. Rovers, Tim M. Govers, Petra L. M. Zusterzeel

*Corresponding author for this work

Research output: Contribution to journalArticleAcademicpeer-review

3 Citations (Web of Science)

Abstract

Objective. To assess the cost-effectiveness of sentinel lymph node mapping compared to risk factor assessment and routine full lymph node dissection for the assessment of lymph nodes in patients with low-and intermediate-risk endometrioid endometrial cancer.

Methods. A decision-analytic model was designed to compare three lymph node assessment strategies in terms of costs and effects: 1) sentinel lymph node mapping; 2) post-operative risk factor assessment (adjuvant therapy based on clinical and histological risk factors); 3) full lymph node dissection. Input data were derived from systematic literature searches and expert opinion. QALYs were used as measure of effectiveness. The model was built from a healthcare perspective and the impact of uncertainty was assessed with sensitivity analyses.

Results. Base-case analysis showed that sentinel lymph node mapping was the most effective strategy for lymph node assessment in patients with low-and intermediate-risk endometrial cancer. Compared to risk factor assessment it was more costly, but the incremental cost effectiveness ratio stayed below a willingness-to-pay threshold of epsilon 20,000 with a maximum of epsilon 9637/QALY. Sentinel lymph node mapping was dominant compared to lymph node dissection since it was more effective and less costly. Sensitivity analyses showed that the outcome of the model was robust to changes in input values. With a willingness-to-pay threshold of epsilon 20,000 sentinel lymph node mapping remained cost-effective in at least 74.3% of the iterations.

Conclusion. Sentinel lymph node mapping is the most cost-effective strategy to guide the need for adjuvant therapy in patients with low and intermediate risk endometrioid endometrial cancer.

(c) 2021 The Authors. Published by Elsevier Inc. This is an open access article under the CC BY license (http:// creativecommons.org/licenses/by/4.0/).

Original languageEnglish
Pages (from-to)251-260
Number of pages10
JournalGynecologic Oncology
Volume161
Issue number1
DOIs
Publication statusPublished - Apr 2021

Keywords

  • Endometrial cancer
  • Sentinel lymph node mapping
  • Cost-effectiveness
  • LOWER-LIMB LYMPHEDEMA
  • LOWER-EXTREMITY LYMPHEDEMA
  • QUALITY-OF-LIFE
  • PARAAORTIC LYMPHADENECTOMY
  • SELECTIVE LYMPHADENECTOMY
  • RETROSPECTIVE ANALYSIS
  • MRC ASTEC
  • COMPLICATIONS
  • CARCINOMA
  • RADIOTHERAPY

Cite this