Sentinel lymph node (SLN) mapping is cost-effective compared with other methods of lymphadenectomy (LND) in the management of low-risk endometrial carcinoma, according to a decision analysis model study presented at the 2017 Society of Gynecologic Oncology Annual Meeting.1
The purpose of this study was to evaluate the cost-effectiveness of several LND strategies in low-risk endometrial carcinoma. The model compared routine LND resulting in 100% LND, selective LND based on intraoperative frozen section resulting in 60% LND, and sentinel lymph node (SLN) mapping based on the Memorial Sloan Kettering algorithm resulting in 15% of contralateral side-specific LND and 5% bilateral LND among women undergoing minimally invasive surgery.
Effectiveness was defined as 3-year disease-specific survival (DFS) adjusted for effect of lymphedema on quality of life. Incremental cost-effectiveness ratios (ICERs) per quality-adjusted life years (QALYs) gained were calculated based on 2016 US dollars and a discounted annual rate of 3%.
The study estimated that the annual cost of routine LND was $722 million compared with $681 million for selective LND, and $656 million for SLN mapping.
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The cost of routine LND was $18,041 with an effectiveness of 2.79 QALYs, whereas selective LND had a cost of $17,036 with an effectiveness of 2.81 QALYs, and SLN mapping had a cost of $16,401 with an effectiveness of 2.87 QALYs. ICER could not be determined for any of the groups.
These data suggest that SLN mapping is more cost-effective and more efficacious than routine LND or selective LND.
- Suidan RS, Sun CC, Cantor SB, et al. A cost-utility analysis of sentinel lymph node mapping, selective lymphadenectomy, and routine lymphadenectomy in the management of low-risk endometrial carcinoma. Paper presented at: 48th Annual Meeting of the Society of Gynecologic Oncology; March 12-15, 2017; National Harbor, MD.