Cost‐effectiveness of Choosing Wisely guidelines for axillary observation in women older than age 70 years with hormone receptor–positive, clinically node‐negative, operable breast tumors
Background The Society for Surgical Oncology's Choosing Wisely guidelines recommend against sentinel lymph node biopsy (SLNB) in favor of observation in this population. Recent analyses reveal that this has not been widely adopted. The purpose of this cost‐effectiveness analysis is to compare t...
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Published in | Cancer Vol. 128; no. 12; pp. 2258 - 2268 |
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Main Authors | , , , , |
Format | Journal Article |
Language | English |
Published |
United States
Wiley Subscription Services, Inc
15.06.2022
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Abstract | Background
The Society for Surgical Oncology's Choosing Wisely guidelines recommend against sentinel lymph node biopsy (SLNB) in favor of observation in this population. Recent analyses reveal that this has not been widely adopted. The purpose of this cost‐effectiveness analysis is to compare the costs and benefits associated with observation or SLNB in women >70 years old with hormone receptor–positive, clinically node‐negative, operable breast cancer.
Methods
A decision tree with Markov modeling was created to compare treatment strategies using long‐term follow‐up data from clinical trials in this population. Costs were estimated from published literature and publicly available databases. Breast cancer–specific health‐state utilities were derived from the literature and expert opinion. One‐way, 2‐way, and probabilistic sensitivity analyses were conducted. A structural sensitivity analysis was performed to assess the effect of functional status and anxiety from nonevaluation of the axilla on cost‐effectiveness. Costs and benefits, measured in life‐years (LYs) and quality‐adjusted life‐years (QALYs), were tabulated across 10, 15, and 20 years and compared using incremental cost‐effectiveness ratios (ICERs).
Results
SLNB is not cost‐effective from the payer or societal perspectives with ICERs of $138,374/LY and $131,900/LY, respectively. When QALYs were considered, SLNB provided fewer QALYs (SLNB, 10.33 QALYs; observation, 10.53 QALYs) at a higher cost (SLNB, $15,845; observation, $4020). Structural sensitivity analysis revealed that SLNB was cost‐effective in certain patients with significant anxiety related to axillary observation (ICER, $39,417/QALY).
Conclusions
Routine SLNB in this population is not cost‐effective. The cost‐effectiveness of SLNB, however, is dependent on individual patient factors, including functional status as well as patient preference. |
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AbstractList | The Society for Surgical Oncology's Choosing Wisely guidelines recommend against sentinel lymph node biopsy (SLNB) in favor of observation in this population. Recent analyses reveal that this has not been widely adopted. The purpose of this cost-effectiveness analysis is to compare the costs and benefits associated with observation or SLNB in women >70 years old with hormone receptor-positive, clinically node-negative, operable breast cancer.
A decision tree with Markov modeling was created to compare treatment strategies using long-term follow-up data from clinical trials in this population. Costs were estimated from published literature and publicly available databases. Breast cancer-specific health-state utilities were derived from the literature and expert opinion. One-way, 2-way, and probabilistic sensitivity analyses were conducted. A structural sensitivity analysis was performed to assess the effect of functional status and anxiety from nonevaluation of the axilla on cost-effectiveness. Costs and benefits, measured in life-years (LYs) and quality-adjusted life-years (QALYs), were tabulated across 10, 15, and 20 years and compared using incremental cost-effectiveness ratios (ICERs).
SLNB is not cost-effective from the payer or societal perspectives with ICERs of $138,374/LY and $131,900/LY, respectively. When QALYs were considered, SLNB provided fewer QALYs (SLNB, 10.33 QALYs; observation, 10.53 QALYs) at a higher cost (SLNB, $15,845; observation, $4020). Structural sensitivity analysis revealed that SLNB was cost-effective in certain patients with significant anxiety related to axillary observation (ICER, $39,417/QALY).
Routine SLNB in this population is not cost-effective. The cost-effectiveness of SLNB, however, is dependent on individual patient factors, including functional status as well as patient preference. BACKGROUNDThe Society for Surgical Oncology's Choosing Wisely guidelines recommend against sentinel lymph node biopsy (SLNB) in favor of observation in this population. Recent analyses reveal that this has not been widely adopted. The purpose of this cost-effectiveness analysis is to compare the costs and benefits associated with observation or SLNB in women >70 years old with hormone receptor-positive, clinically node-negative, operable breast cancer.METHODSA decision tree with Markov modeling was created to compare treatment strategies using long-term follow-up data from clinical trials in this population. Costs were estimated from published literature and publicly available databases. Breast cancer-specific health-state utilities were derived from the literature and expert opinion. One-way, 2-way, and probabilistic sensitivity analyses were conducted. A structural sensitivity analysis was performed to assess the effect of functional status and anxiety from nonevaluation of the axilla on cost-effectiveness. Costs and benefits, measured in life-years (LYs) and quality-adjusted life-years (QALYs), were tabulated across 10, 15, and 20 years and compared using incremental cost-effectiveness ratios (ICERs).RESULTSSLNB is not cost-effective from the payer or societal perspectives with ICERs of $138,374/LY and $131,900/LY, respectively. When QALYs were considered, SLNB provided fewer QALYs (SLNB, 10.33 QALYs; observation, 10.53 QALYs) at a higher cost (SLNB, $15,845; observation, $4020). Structural sensitivity analysis revealed that SLNB was cost-effective in certain patients with significant anxiety related to axillary observation (ICER, $39,417/QALY).CONCLUSIONSRoutine SLNB in this population is not cost-effective. The cost-effectiveness of SLNB, however, is dependent on individual patient factors, including functional status as well as patient preference. Background The Society for Surgical Oncology's Choosing Wisely guidelines recommend against sentinel lymph node biopsy (SLNB) in favor of observation in this population. Recent analyses reveal that this has not been widely adopted. The purpose of this cost‐effectiveness analysis is to compare the costs and benefits associated with observation or SLNB in women >70 years old with hormone receptor–positive, clinically node‐negative, operable breast cancer. Methods A decision tree with Markov modeling was created to compare treatment strategies using long‐term follow‐up data from clinical trials in this population. Costs were estimated from published literature and publicly available databases. Breast cancer–specific health‐state utilities were derived from the literature and expert opinion. One‐way, 2‐way, and probabilistic sensitivity analyses were conducted. A structural sensitivity analysis was performed to assess the effect of functional status and anxiety from nonevaluation of the axilla on cost‐effectiveness. Costs and benefits, measured in life‐years (LYs) and quality‐adjusted life‐years (QALYs), were tabulated across 10, 15, and 20 years and compared using incremental cost‐effectiveness ratios (ICERs). Results SLNB is not cost‐effective from the payer or societal perspectives with ICERs of $138,374/LY and $131,900/LY, respectively. When QALYs were considered, SLNB provided fewer QALYs (SLNB, 10.33 QALYs; observation, 10.53 QALYs) at a higher cost (SLNB, $15,845; observation, $4020). Structural sensitivity analysis revealed that SLNB was cost‐effective in certain patients with significant anxiety related to axillary observation (ICER, $39,417/QALY). Conclusions Routine SLNB in this population is not cost‐effective. The cost‐effectiveness of SLNB, however, is dependent on individual patient factors, including functional status as well as patient preference. |
Author | Hrebinko, Katherine A. Downs‐Canner, Stephanie Bryce, Cindy L. Diego, Emilia J. Myers, Sara P. |
Author_xml | – sequence: 1 givenname: Katherine A. orcidid: 0000-0001-7350-9033 surname: Hrebinko fullname: Hrebinko, Katherine A. email: hrebinkoka3@upmc.edu organization: University of Pittsburgh Medical Center – sequence: 2 givenname: Cindy L. surname: Bryce fullname: Bryce, Cindy L. organization: University of Pittsburgh Graduate School of Public Health – sequence: 3 givenname: Stephanie orcidid: 0000-0002-6870-3285 surname: Downs‐Canner fullname: Downs‐Canner, Stephanie organization: Memorial Sloan Kettering Cancer Center – sequence: 4 givenname: Emilia J. surname: Diego fullname: Diego, Emilia J. organization: University of Pittsburgh Medical Center – sequence: 5 givenname: Sara P. surname: Myers fullname: Myers, Sara P. organization: University of Pittsburgh Medical Center |
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CitedBy_id | crossref_primary_10_1016_j_clbc_2023_12_007 crossref_primary_10_1016_j_jgo_2024_101795 crossref_primary_10_1245_s10434_024_15000_w crossref_primary_10_1016_j_surg_2022_09_016 |
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The Society for Surgical Oncology's Choosing Wisely guidelines recommend against sentinel lymph node biopsy (SLNB) in favor of observation in this... The Society for Surgical Oncology's Choosing Wisely guidelines recommend against sentinel lymph node biopsy (SLNB) in favor of observation in this population.... BackgroundThe Society for Surgical Oncology's Choosing Wisely guidelines recommend against sentinel lymph node biopsy (SLNB) in favor of observation in this... BACKGROUNDThe Society for Surgical Oncology's Choosing Wisely guidelines recommend against sentinel lymph node biopsy (SLNB) in favor of observation in this... |
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SubjectTerms | Aged Anxiety Axilla - pathology Biopsy Breast cancer breast neoplasms Breast Neoplasms - pathology Clinical trials Cost benefit analysis Costs cost‐utility analysis Decision trees Female Guidelines Humans Lymph Node Excision Lymph nodes Markov chains Oncology Patients Quality-Adjusted Life Years Receptors Sensitivity analysis Sentinel Lymph Node Biopsy surgical oncology Tumors |
Title | Cost‐effectiveness of Choosing Wisely guidelines for axillary observation in women older than age 70 years with hormone receptor–positive, clinically node‐negative, operable breast tumors |
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