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Sentinel lymph node biopsy for head and neck cutaneous squamous cell carcinoma using the Brigham and Women’s staging system: a cost analysis

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Abstract

The objective is to determine the cost-effectiveness of sentinel lymph node biopsy (SLNB) for cutaneous squamous cell carcinoma (CSCC) according to the Brigham and Women’s Hospital (BWH) Tumor Staging system. A decision analysis was utilized to examine costs and outcomes associated with the use of SLNB in patients with high-risk head and neck CSCC. Decision tree outcome probabilities were obtained from published literature. Costs were derived from Medicare reimbursement rates (US$) and effectiveness was represented by quality-adjusted life-years (QALYs). The primary outcome was the incremental cost-effectiveness ratio (ICER), with a willingness-to-pay set at $100,000 per QALY gained. SLNB was found to be a cost-effective tool for patients with T3 tumors, with an ICER of $18,110.57. Withholding SLNB was the dominant strategy for both T2a and T2b lesions, with ICERs of − $2468.99 and − $16,694.00, respectively. Withholding SLNB remained the dominant strategy when examining immunosuppressed patients with T2a or T2b lesions. In patients with head and neck CSCC, those with T3 or T2b lesions with additional risk factors not accounted for in the staging system alone, may be considered for SLNB, while in other tumor stages it may be impractical. SLNB should only be offered on an individual patient basis.

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Authors and Affiliations

  1. Department of Surgery, The Ohio State University Wexner Medical Center, Columbus, OH, USA

    Patrick L. Quinn

  2. Division of Surgical Oncology, Department of Surgery, Rutgers New Jersey Medical School, 205 South Orange Ave, F1222, Newark, NJ, 07103, USA

    Patrick L. Quinn, Jin K. Kim, Vishnu Prasath, Neal Panse & Ravi J. Chokshi

  3. Department of Dermatology, Metrohealth System, Cleveland, OH, USA

    Thomas J. Knackstedt

  4. School of Medicine, Case Western Reserve University, Cleveland, OH, USA

    Thomas J. Knackstedt

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  1. Patrick L. Quinn
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Contributions

All authors contributed to the conception and design, acquisition of data, analysis, interpretation of data, and final approval of the manuscript. PLQ, JKK, VP, TJK and RJC contributed to the drafting of the article. The critical revision of the article was performed by all of the authors.

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Correspondence to Ravi J. Chokshi.

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Conflict of interest

Dr. Patrick L. Quinn, Dr. Jin K. Kim, Mr. Vishnu Prasath, Mr. Neal Panse, Dr. Thomas J. Knackstedt, and Dr. Ravi J. Chokshi have no conflicts of interest or financial ties to disclose.

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Quinn, P.L., Kim, J.K., Prasath, V. et al. Sentinel lymph node biopsy for head and neck cutaneous squamous cell carcinoma using the Brigham and Women’s staging system: a cost analysis. Arch Dermatol Res 315, 371–378 (2023). https://doi.org/10.1007/s00403-022-02347-x

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  • DOI: https://doi.org/10.1007/s00403-022-02347-x

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