Related Experiment Video
Updated: May 17, 2026
Transoral Robotic Total Thyroidectomy and Bilateral Central Regional Lymph Node Dissection for Papillary Thyroid Carcinoma
Published on: September 15, 2023
Cost-Effectiveness Analysis of Transoral Robotic Surgery Versus Radiotherapy Alone for Early-Stage HPV-Associated
Lan Gao1, June Corry2,3, Danny Rischin4,5
1Deakin Health Economics, Institute for Health Transformation, Faculty of Health, Deakin University, Burwood, Victoria, Australia.
Introduction:
Transoral robotic surgery (TORS) and radiotherapy are both recognised as effective treatment options for early-stage HPV-associated oropharyngeal squamous cell carcinoma (HPV-OPSCC). TORS offers the benefit of a shorter total treatment duration; however, a proportion of patients require adjuvant radiotherapy with or without concurrent chemotherapy. Given the equivalence in oncological outcomes and difference in potential costs associated with these two treatments, we sought to perform an economic analysis to assess the incremental cost-effectiveness of TORS compared to radiotherapy.
Methods:
We developed a Markov model to assess the cost-effectiveness of TORS versus radiotherapy for clinical stage T1-2 N0-1 (AJCC 7th edition) HPV-OPSCC. Utility values for health states were informed by EQ-5D-5L from a TROG 12.01. We adopted the Australian healthcare perspective to measure healthcare costs and outcomes, and costs were valued in 2023 Australian dollars (AUD). The incremental cost-effectiveness ratio (ICER) was calculated as the ratio of incremental cost against the incremental quality-adjusted life years (QALY) between two treatment groups. Parameter uncertainties were assessed through sensitivity analysis.
Results:
The total costs/QALY for TORS and radiotherapy were $85,317/8.995 QALY and $57,833/8.519 QALY, respectively. This resulted in an ICER of $57,749/QALY gained with TORS. In sensitivity analysis, ICER was highly sensitive to the cost of TORS, distant recurrent disease, probability of salvage surgery after radiotherapy, discount rate, and the locoregional recurrent disease.
Conclusion:
From an Australian healthcare system perspective, TORS is not cost-effective compared to radiotherapy alone for early-stage HPV-OPSCC based on healthcare associated cost.
