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Head and neck cancers

866 - PET-CT surveillance for advanced head and neck cancer: a cost-effective alternative to planned neck dissection?


08 Oct 2016


Head and neck cancers


Alison Smith


Annals of Oncology (2016) 27 (6): 328-350. 10.1093/annonc/mdw376


A.F. Smith1, P.S. Hall2, C. Hulme1, C. McConkey3, J.A. Dunn3, J. Rahman3, H. Mehanna4

Author affiliations

  • 1 Academic Unit Of Health Economics, University of Leeds-Institute of Health Sciences, LS2 9LJ - Leeds/GB
  • 2 Cancer Research Centre, Edinburgh Cancer Centre Western General Hospital, EH4 2XR - Edinburgh/GB
  • 3 Clinical Trials Unit, University of Warwick, CV4 7AL - Coventry/GB
  • 4 Institute Of Head And Neck Studies And Education, The University of Birmingham Institute for Cancer Studies, B15 2TT - Birmingham/GB


Abstract 866


Despite controversy, planned neck dissection (ND) remains standard treatment for patients with locally advanced head and neck squamous cell carcinoma after radical chemo-radiotherapy. FDG-PET-CT scanning has demonstrated high negative predictive values for persistent disease, and could thereby enable low risk patients to be spared from unnecessary surgery. Evidence of the cost-effectiveness of PET-CT surveillance strategies is limited however, and no evaluations have yet been conducted from a UK perspective.


An economic evaluation was conducted to assess the lifetime cost-effectiveness of PET-CT surveillance versus planned ND from a UK secondary care perspective. Cost and health outcomes associated with the initial 6-month treatment period (CRT +/- ND) were derived from individual data on 564 patients from a recent UK multicentre randomised controlled trial (PET-Neck). Subsequent outcomes were derived using a constructed Markov model to track patients through four health states: disease-free, local recurrence, distant recurrence and dead. Model inputs were derived from trial data and literature sources.


PET-CT surveillance results in a lifetime cost saving of -£1,485 (95% CI: -2,815 to 159) and health gain of +0.13 (95% CI: -0.49 to +0.79) quality-adjusted life-years (QALYs) per patient. The intervention therefore dominates standard care, being more effective and less costly, with an incremental net benefit (INB) of +0.21 QALYs (95% CI: -0.41 to +0.85). At a willingness-to-pay per QALY threshold of £20,000, PET-CT is associated with a 75% probability of being cost-effective, dropping to 68% at a £100,000/QALY threshold. The intervention remained cost-effective when considering a broader NHS and personal social services perspective; however, uncertainty around the mean cost-effectiveness values was wide.


PET-CT surveillance appears to be cost-effective, leading to expected lifetime cost savings and a marginal health increment. There is significant uncertainty in the longer term which may warrant additional survivor-ship research.

Clinical trial identification

ISRCTN 13735240

Legal entity responsible for the study

Warwick Medical School.


National Institute for Health Research (NIHR) Health Technology Assessment (HTA) Programme (project number 06/302/129).


All authors have declared no conflicts of interest.

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