Transoral Robotic Surgery and the Unknown Primary: A Cost-Effectiveness Analysis

Area of Science:

• Otolaryngology
• Surgical Oncology
• Health Economics

Background:

• Unknown primary squamous cell carcinoma (CUP) of the head and neck presents a diagnostic challenge.
• Traditional diagnostic methods may have limitations in identifying the primary tumor site.

Purpose of the Study:

• To evaluate the cost-effectiveness of transoral robotic surgery (TORS) for diagnosing and treating cervical unknown primary squamous cell carcinoma (CUP).

Main Methods:

• Retrospective chart review of 22 patients treated with TORS for CUP between 2009 and 2012.
• Analysis of direct hospital costs and national data for inpatient and physician fees.
• Calculation of incremental cost-effectiveness ratios (ICERs) for different diagnostic strategies.

Main Results:

• TORS identified the primary tumor in 19 of 22 patients (86.4%).
• The ICER for sequential examination under anesthesia (EUA) with tonsillectomy followed by TORS was $8619 per additional primary identified.
• The ICER for simultaneous EUA with tonsillectomy and TORS base of tongue resection was $5774 per additional primary identified.

Conclusions:

• Sequential EUA followed by TORS demonstrates a favorable ICER compared to traditional EUA alone for CUP diagnosis.
• Bilateral base of tongue resection via TORS should be considered in the workup of CUP patients, especially if palatine tonsils are absent.