Suidan RS, et al. - The cost-utility of three lymphadenectomy strategies in the management of low-risk endometrial carcinoma was assessed. Sentinel lymph node mapping had the lowest costs and highest quality-adjusted survival compared with routine and selective lymphadenectomy, so it is the most cost-effective strategy in the management of low-risk endometrial carcinoma.

Methods

• Three lymphadenectomy strategies were compared in women undergoing minimally invasive surgery for low-risk endometrial carcinoma using a decision analysis model: 1) routine lymphadenectomy in all patients, 2) selective lymphadenectomy based on intraoperative frozen section criteria, and 3) sentinel lymph node mapping.
• From published literature and Medicare reimbursement rates, researchers obtained costs and outcomes.
• For this work, cost categories consisted of hospital, physician, operating room, pathology, and lymphedema treatment.
• They defined effectiveness as 3-year disease-specific survival adjusted for the effect of lymphedema (utility=0.8) on quality of life.
• A cost-utility analysis comparing the different strategies was undertaken.
• They performed multiple deterministic sensitivity analyses.

Results

• Routine lymphadenectomy had a cost of $18,041 and an effectiveness of 2.79 quality-adjusted life-years (QALYs) in the base-case scenario.
• A cost of $17,036 and an effectiveness of 2.81 QALYs were noted with selective lymphadenectomy, whereas sentinel lymph node mapping had a cost of $16,401 and an effectiveness of 2.87 QALYs.
• Selective lymphadenectomy, compared with routine lymphadenectomy, was both less costly and more effective with a difference of $1,005 and 0.02 QALYs.
• However, sentinel lymph node mapping had the lowest cost and highest effectiveness, and was therefore the most cost-effective strategy.
• The findings were robust in multiple sensitivity analyses varying the rates of lymphedema and lymphadenectomy, surgical approach (open or minimally invasive surgery), lymphedema utility, and costs.
• The annual cost of routine lymphadenectomy, selective lymphadenectomy, and sentinel lymph node mapping would be $722 million, $681 million, and $656 million, respectively, for the estimated 40,000 women undergoing surgery for low-risk endometrial carcinoma each year in the United States.