Background and purpose:
Transoral robotic surgery (TORS) and radiotherapy are both recognised as effective treatment options for early-stage HPV-associated oropharyngeal squamous cell carcinoma (HPV-OPSCC). The benefit of TORS is shorter total treatment duration, however a large proportion of patients still require adjuvant radiotherapy with or without concurrent chemotherapy.
Aims:
Given the difference in potential costs and outcome associated with these two treatments, we sought to perform an economic analysis to assess the incremental cost-effectiveness of TORS compared with radiotherapy.
Materials and methods:
We developed a Markov model to assess the cost-effectiveness of TORS versus radiotherapy for clinical stage T1-2 N0-1 (AJCC 7) HPV-OPSCC. The EQ5D from a TROG trial was used to inform the utility values for health states. Transition probabilities were sourced from literature. We adopted the Australian health care perspective to measure healthcare costs and was valued in 2023 Australian dollars (AUD). The incremental cost-effectiveness ratio (ICER) was expressed as the ratio of incremental cost against the incremental quality-adjusted life years (QALY) between two treatment groups. The parameter uncertainties was assessed by sensitive analysis.
Results:
TORS and Radiotherapy yielded an average of 9.92 QALY vs. 9.91 QALY gains at a cost of $91,118 vs. $61,618 respectively. This resulted in an ICER of $1,920,005/QALY gained with TORS. ICER was very sensitive to the variation in the probability of the residual disease following TORS, utility weights of distant recurrence disease, probability of having salvage surgery for residual disease, discount rate, and the utility weights of local, regional recurrence disease.
Conclusion: In this study, from an Australian health care system perspective, TORS is unlikely to be cost-effective, compared to radiotherapy alone for early-stage HPV-OPSCC.