Cost-effectiveness Analysis Of Radiotherapy After Primary Surgery And Neck Dissection For T_1-2N₁ Oral Cancer Patients

Objective:Oral cancer has an important impact on the patient's economy and quality of life.There is no clear conclusion as to whether there should be radiotherapy after neck dissection in patients with T_1-2N₁ oral cancer.Previous studies have focused on survival rates,quality of life or study medical expenses.our research hopes to combine the above studies to discuss the clinical value and social significance of postoperative radiotherapy for cervical cancer in patients with T_1-2N₁ oral cancer from the perspective of cost-effectiveness.Method:We modeled the postoperative state and its changes by constructing a Markov model.The four basic states are:no evidence of disease,salvaged,palliative,and dead.Raw data on state transition probabilities,medical costs,and quality of life are all derived from the literature.Methods of analysis include Markov cohort analysis,incremental cost-effectiveness ratio,net benefit analysis,deterministic sensitivity analysis and probabilistic sensitivity analysis based on Monte Carlo simulation.Results:Markov cohort analysis found that after 30 years,the expected cost of radiotherapy group was 65728 USD,the expected effectiveness was 14.12 QALY;the expected cost of without-radiotherapy group was 49465 USD,and the expected effectiveness was 10.61 QALY.Since postoperative radiotherapy reduces the recurrence rate,the expected effectiveness in the radiotherapy group is still better than the without-radiotherapy group.Monte Carlo simulation results show that under current willingness-to-pay,postoperative radiotherapy is an acceptable strategy.Deterministic sensitivity analysis found that if the expected cost of the radiotherapy group was lower than that of the non-radiotherapy group,the initial radiotherapy cost would be less than 5038 USD.Conclusion:For patients with T_1-2N₁ oral cancer after neck dessection,radiotherapy has a higher survival benefit at a slightly higher cost.Under generally accepted willingness-to-pay,postoperative radiotherapy is acceptable.To get more effectiveness at a lower cost,the price of radiotherapy needs to be reduced by 76%.