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Cost-Utility Analysis of Sentinel Node Biopsy Versus Selective Neck Dissection for Node-Negative Early-Stage Oral
Krishnakumar Thankappan1, Lakshmi Ravunniarth Menon1, Tejal Patel1
1Department of Head and Neck Surgery and Oncology, Amrita Institute of Medical Sciences, Amrita Vishwa Vidyapeetham, Kochi, India.
Objectives:
To conduct a cost-utility analysis comparing sentinel node biopsy (SNB) with selective neck dissection (SND) for clinically node-negative early-stage oral cancer from the Indian healthcare system perspective.
Methods:
A hybrid decision-tree-Markov model compared SNB with SND over a 10-year horizon, incorporating 18 clinical pathways, time-trade-off utilities from an Indian population, and costs from Indian settings. Model and R code construction were assisted by a large language model (Claude-3.5-Sonnet) with author verification. Effectiveness was measured in quality-adjusted life-years (QALYs). Deterministic and probabilistic sensitivity analyses were conducted. The primary outcome was net monetary benefit at the India-specific willingness-to-pay threshold of INR 212 307/QALY.
Results:
SNB yielded 6.145 QALYs versus 6.032 for SND (incremental 0.114) at INR 332 865 versus INR 336 433 (incremental -INR 3568). SNB dominated SND in the deterministic base case. Under probabilistic sensitivity analysis, SNB was cost-effective in 78.5% of iterations at the India-specific threshold (mean incremental net monetary benefit INR 15 944; 95% CrI -INR 22 141 to INR 54 287) and 81.8% at 1× gross domestic product per capita (INR 245 000/QALY). A lifetime-horizon scenario (cohort age 55-100; 45 cycles) confirmed SNB dominance with incremental cost -INR 5466 and incremental QALYs 0.1767. Results were robust across deterministic and scenario analyses.
Conclusions:
SNB is a cost-effective alternative to SND for clinically node-negative early-stage oral cancer in Indian tertiary cancer centers with appropriate technical expertise, dominating in the deterministic base case and remaining cost-effective in 78.5% of probabilistic iterations at the India-specific threshold. These findings support adoption of SNB as the preferred staging strategy at such centers.
