Cost-effectiveness analysis of PET-CT-guided management for locally advanced head and neck cancer

Purpose: A recent large UK clinical trial demonstrated that positron-emission tomography–computed tomography (PET-CT)- guided administration of neck dissection in patients with advanced head and neck cancer after primary chemo-radiotherapy treatment produces similar survival outcomes to planned neck dissection (standard care) and is cost-effective over a short-term horizon. Further assessment of long-term outcomes is required in order to inform a robust adoption decision. Here we present results of a lifetime cost-effectiveness analysis of PET-CT guided management from a UK National Health Service (NHS) secondary care perspective.Methods: Initial 6-month cost and health outcomes were derived from trial data; subsequent incidence of recurrence events and mortality was simulated using a de novo Markov model. Health benefit was measured in quality adjusted life years (QALYs) and costs reported in 2015 British pounds. Model transition probabilities, costs and utilities were derived from trial data and published literature. Sensitivity analyses were conducted to assess the impact of uncertainty and broader NHS & personal social services (PSS) costs on the results. Results: PET-CT management produced an average lifetime NHS secondary care cost saving of £1,485 [$2,133] (95% CI: -2,815 to 159) and an additional 0.13 QALYs (95% CI: -0.49 to 0.79). At a £20,000 [$28,736] willingness-to-pay per additional QALY threshold there was a 75% probability that PET-CT was cost-effective, and the results remained cost-effective over the majority of sensitivity analyses. When adopting a broader NHS & PSS perspective, PET-CT management produced an average saving of £700 [$1,005] (95% CI: -6,190 to 5,362) and had an 81% probability of being cost-effective. Conclusions: This analysis indicates that PET-CT guided management is cost-effective in the long-term and supports the case for adoption.