Effectiveness and cost-effectiveness of sentinel lymph node biopsy compared with axillary node dissection in patients with early-stage breast cancer: a decision model analysis
Identifieur interne : 004370 ( Main/Merge ); précédent : 004369; suivant : 004371Effectiveness and cost-effectiveness of sentinel lymph node biopsy compared with axillary node dissection in patients with early-stage breast cancer: a decision model analysis
Auteurs : H. Verry [Australie] ; S J Lord [Australie] ; A. Martin [Australie] ; G. Gill [Australie] ; C K Lee [Australie] ; K. Howard [Australie] ; N. Wetzig [Australie] ; J. Simes [Australie]Source :
- British Journal of Cancer [ 0007-0920 ] ; 2012.
Descripteurs français
- KwdFr :
- Aisselle, Analyse coût-bénéfice, Biopsie de noeud lymphatique sentinelle (économie), Chaines de Markov, Essais contrôlés randomisés comme sujet, Femelle, Humains, Lymphadénectomie (économie), Métastase lymphatique, Sensibilité et spécificité, Stade de la tumeur (), Techniques d'aide à la décision, Tumeurs du sein (anatomopathologie), Tumeurs du sein (diagnostic).
- MESH :
- anatomopathologie : Tumeurs du sein.
- diagnostic : Tumeurs du sein.
- économie : Biopsie de noeud lymphatique sentinelle, Lymphadénectomie.
- Aisselle, Analyse coût-bénéfice, Chaines de Markov, Essais contrôlés randomisés comme sujet, Femelle, Humains, Métastase lymphatique, Sensibilité et spécificité, Stade de la tumeur, Techniques d'aide à la décision.
English descriptors
- KwdEn :
- Axilla, Breast Neoplasms (diagnosis), Breast Neoplasms (pathology), Cost-Benefit Analysis, Decision Support Techniques, Female, Humans, Lymph Node Excision (economics), Lymphatic Metastasis, Markov Chains, Neoplasm Staging (methods), Randomized Controlled Trials as Topic, Sensitivity and Specificity, Sentinel Lymph Node Biopsy (economics).
- MESH :
- diagnosis : Breast Neoplasms.
- economics : Lymph Node Excision, Sentinel Lymph Node Biopsy.
- methods : Neoplasm Staging.
- pathology : Breast Neoplasms.
- Axilla, Cost-Benefit Analysis, Decision Support Techniques, Female, Humans, Lymphatic Metastasis, Markov Chains, Randomized Controlled Trials as Topic, Sensitivity and Specificity.
Abstract
Sentinel lymph node biopsy (SLNB) is less invasive than axillary lymph node dissection (ALND) for staging early breast cancer, and has a lower risk of arm lymphoedema and similar rates of locoregional recurrence up to 8 years. This study estimates the longer-term effectiveness and cost-effectiveness of SLNB.
A Markov decision model was developed to estimate the incremental quality-adjusted life years (QALYs) and costs of an SLNB-based staging and management strategy compared with ALND over 20 years' follow-up. The probability and quality-of-life weighting (utility) of outcomes were estimated from published data and population statistics. Costs were estimated from the perspective of the Australian health care system. The model was used to identify key factors affecting treatment decisions.
The SLNB was more effective and less costly than the ALND over 20 years, with 8 QALYs gained and $883 000 saved per 1000 patients. The SLNB was less effective when: SLNB false negative (FN) rate >13% 5-year incidence of axillary recurrence after an SLNB FN>19% risk of an SLNB-positive result >48% lymphoedema prevalence after ALND <14% or lymphoedema utility decrement <0.012.
The long-term advantage of SLNB over ALND was modest and sensitive to variations in key assumptions, indicating a need for reliable information on lymphoedema incidence and disutility following SLNB. In addition to awaiting longer-term trial data, risk models to better identify patients at high risk of axillary metastasis will be valuable to inform decision-making.
Url:
DOI: 10.1038/bjc.2012.62
PubMed: 22415293
PubMed Central: 3304429
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PMC:3304429Le document en format XML
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Verry</name><affiliation wicri:level="1"><nlm:aff id="aff1"><institution>NHMRC Clinical Trials Centre, University of Sydney</institution>, Locked Bag 77, Camperdown, New South Wales 2050,<country>Australia</country></nlm:aff><country xml:lang="fr">Australie</country><wicri:regionArea># see nlm:aff country strict</wicri:regionArea></affiliation></author><author><name sortKey="Lord, S J" sort="Lord, S J" uniqKey="Lord S" first="S J" last="Lord">S J Lord</name><affiliation wicri:level="1"><nlm:aff id="aff1"><institution>NHMRC Clinical Trials Centre, University of Sydney</institution>, Locked Bag 77, Camperdown, New South Wales 2050,<country>Australia</country></nlm:aff><country xml:lang="fr">Australie</country><wicri:regionArea># see nlm:aff country strict</wicri:regionArea></affiliation></author><author><name sortKey="Martin, A" sort="Martin, A" uniqKey="Martin A" first="A" last="Martin">A. Martin</name><affiliation wicri:level="1"><nlm:aff id="aff1"><institution>NHMRC Clinical Trials Centre, University of Sydney</institution>, Locked Bag 77, Camperdown, New South Wales 2050,<country>Australia</country></nlm:aff><country xml:lang="fr">Australie</country><wicri:regionArea># see nlm:aff country strict</wicri:regionArea></affiliation></author><author><name sortKey="Gill, G" sort="Gill, G" uniqKey="Gill G" first="G" last="Gill">G. Gill</name><affiliation wicri:level="1"><nlm:aff id="aff2"><institution>Department of Surgery, University of Adelaide</institution>, Adelaide, South Australia 5005,<country>Australia</country></nlm:aff><country xml:lang="fr">Australie</country><wicri:regionArea># see nlm:aff country strict</wicri:regionArea></affiliation></author><author><name sortKey="Lee, C K" sort="Lee, C K" uniqKey="Lee C" first="C K" last="Lee">C K Lee</name><affiliation wicri:level="1"><nlm:aff id="aff1"><institution>NHMRC Clinical Trials Centre, University of Sydney</institution>, Locked Bag 77, Camperdown, New South Wales 2050,<country>Australia</country></nlm:aff><country xml:lang="fr">Australie</country><wicri:regionArea># see nlm:aff country strict</wicri:regionArea></affiliation></author><author><name sortKey="Howard, K" sort="Howard, K" uniqKey="Howard K" first="K" last="Howard">K. Howard</name><affiliation wicri:level="1"><nlm:aff id="aff3"><institution>School of Public Health, University of Sydney</institution>, Edward Ford Building A27, Camperdown, New South Wales 2006,<country>Australia</country></nlm:aff><country xml:lang="fr">Australie</country><wicri:regionArea># see nlm:aff country strict</wicri:regionArea></affiliation></author><author><name sortKey="Wetzig, N" sort="Wetzig, N" uniqKey="Wetzig N" first="N" last="Wetzig">N. Wetzig</name><affiliation wicri:level="1"><nlm:aff id="aff4"><institution>Wesley Medical Centre, Sandford Jackson Building</institution>, 30 Chasely Street, Brisbane, Queensland 4066,<country>Australia</country></nlm:aff><country xml:lang="fr">Australie</country><wicri:regionArea># see nlm:aff country strict</wicri:regionArea></affiliation></author><author><name sortKey="Simes, J" sort="Simes, J" uniqKey="Simes J" first="J" last="Simes">J. Simes</name><affiliation wicri:level="1"><nlm:aff id="aff1"><institution>NHMRC Clinical Trials Centre, University of Sydney</institution>, Locked Bag 77, Camperdown, New South Wales 2050,<country>Australia</country></nlm:aff><country xml:lang="fr">Australie</country><wicri:regionArea># see nlm:aff country strict</wicri:regionArea></affiliation></author></analytic><series><title level="j">British Journal of Cancer</title><idno type="ISSN">0007-0920</idno><idno type="eISSN">1532-1827</idno><imprint><date when="2012">2012</date></imprint></series></biblStruct></sourceDesc></fileDesc><profileDesc><textClass><keywords scheme="KwdEn" xml:lang="en"><term>Axilla</term><term>Breast Neoplasms (diagnosis)</term><term>Breast Neoplasms (pathology)</term><term>Cost-Benefit Analysis</term><term>Decision Support Techniques</term><term>Female</term><term>Humans</term><term>Lymph Node Excision (economics)</term><term>Lymphatic Metastasis</term><term>Markov Chains</term><term>Neoplasm Staging (methods)</term><term>Randomized Controlled Trials as Topic</term><term>Sensitivity and Specificity</term><term>Sentinel Lymph Node Biopsy (economics)</term></keywords><keywords scheme="KwdFr" xml:lang="fr"><term>Aisselle</term><term>Analyse coût-bénéfice</term><term>Biopsie de noeud lymphatique sentinelle (économie)</term><term>Chaines de Markov</term><term>Essais contrôlés randomisés comme sujet</term><term>Femelle</term><term>Humains</term><term>Lymphadénectomie (économie)</term><term>Métastase lymphatique</term><term>Sensibilité et spécificité</term><term>Stade de la tumeur ()</term><term>Techniques d'aide à la décision</term><term>Tumeurs du sein (anatomopathologie)</term><term>Tumeurs du sein (diagnostic)</term></keywords><keywords scheme="MESH" qualifier="anatomopathologie" xml:lang="fr"><term>Tumeurs du sein</term></keywords><keywords scheme="MESH" qualifier="diagnosis" xml:lang="en"><term>Breast Neoplasms</term></keywords><keywords scheme="MESH" qualifier="diagnostic" xml:lang="fr"><term>Tumeurs du sein</term></keywords><keywords scheme="MESH" qualifier="economics" xml:lang="en"><term>Lymph Node Excision</term><term>Sentinel Lymph Node Biopsy</term></keywords><keywords scheme="MESH" qualifier="methods" xml:lang="en"><term>Neoplasm Staging</term></keywords><keywords scheme="MESH" qualifier="pathology" xml:lang="en"><term>Breast Neoplasms</term></keywords><keywords scheme="MESH" qualifier="économie" xml:lang="fr"><term>Biopsie de noeud lymphatique sentinelle</term><term>Lymphadénectomie</term></keywords><keywords scheme="MESH" xml:lang="en"><term>Axilla</term><term>Cost-Benefit Analysis</term><term>Decision Support Techniques</term><term>Female</term><term>Humans</term><term>Lymphatic Metastasis</term><term>Markov Chains</term><term>Randomized Controlled Trials as Topic</term><term>Sensitivity and Specificity</term></keywords><keywords scheme="MESH" xml:lang="fr"><term>Aisselle</term><term>Analyse coût-bénéfice</term><term>Chaines de Markov</term><term>Essais contrôlés randomisés comme sujet</term><term>Femelle</term><term>Humains</term><term>Métastase lymphatique</term><term>Sensibilité et spécificité</term><term>Stade de la tumeur</term><term>Techniques d'aide à la décision</term></keywords></textClass></profileDesc></teiHeader><front><div type="abstract" xml:lang="en"><sec><title>Background:</title><p>Sentinel lymph node biopsy (SLNB) is less invasive than axillary lymph node dissection (ALND) for staging early breast cancer, and has a lower risk of arm lymphoedema and similar rates of locoregional recurrence up to 8 years. This study estimates the longer-term effectiveness and cost-effectiveness of SLNB.</p></sec><sec><title>Methods:</title><p>A Markov decision model was developed to estimate the incremental quality-adjusted life years (QALYs) and costs of an SLNB-based staging and management strategy compared with ALND over 20 years' follow-up. The probability and quality-of-life weighting (utility) of outcomes were estimated from published data and population statistics. Costs were estimated from the perspective of the Australian health care system. The model was used to identify key factors affecting treatment decisions.</p></sec><sec><title>Results:</title><p>The SLNB was more effective and less costly than the ALND over 20 years, with 8 QALYs gained and $883 000 saved per 1000 patients. The SLNB was less effective when: SLNB false negative (FN) rate >13% 5-year incidence of axillary recurrence after an SLNB FN>19% risk of an SLNB-positive result >48% lymphoedema prevalence after ALND <14% or lymphoedema utility decrement <0.012.</p></sec><sec><title>Conclusion:</title><p>The long-term advantage of SLNB over ALND was modest and sensitive to variations in key assumptions, indicating a need for reliable information on lymphoedema incidence and disutility following SLNB. In addition to awaiting longer-term trial data, risk models to better identify patients at high risk of axillary metastasis will be valuable to inform decision-making.</p></sec></div></front><back><div1 type="bibliography"><listBibl><biblStruct><analytic><author><name sortKey="Aebi, S" uniqKey="Aebi S">S Aebi</name></author><author><name sortKey="Davidson, T" uniqKey="Davidson T">T Davidson</name></author><author><name sortKey="Gruber, G" uniqKey="Gruber G">G Gruber</name></author><author><name sortKey="Castiglione, M" uniqKey="Castiglione M">M Castiglione</name></author></analytic></biblStruct><biblStruct><analytic><author><name sortKey="Anderson, Sj" uniqKey="Anderson S">SJ Anderson</name></author><author><name sortKey="Wapnir, I" uniqKey="Wapnir I">I Wapnir</name></author><author><name sortKey="Dignam, Jj" uniqKey="Dignam J">JJ Dignam</name></author><author><name sortKey="Fisher, B" uniqKey="Fisher B">B Fisher</name></author><author><name sortKey="Mamounas, Ep" uniqKey="Mamounas E">EP Mamounas</name></author><author><name sortKey="Jeong, J" uniqKey="Jeong J">J Jeong</name></author><author><name sortKey="Geyer, Jrce" uniqKey="Geyer J">JrCE Geyer</name></author><author><name sortKey="Wickerham, Dl" uniqKey="Wickerham D">DL Wickerham</name></author><author><name sortKey="Costantino, Jp" uniqKey="Costantino J">JP Costantino</name></author><author><name sortKey="Wolmark, N" uniqKey="Wolmark N">N Wolmark</name></author></analytic></biblStruct><biblStruct></biblStruct><biblStruct></biblStruct><biblStruct></biblStruct><biblStruct></biblStruct><biblStruct><analytic><author><name sortKey="Baker, M" uniqKey="Baker M">M Baker</name></author><author><name sortKey="Kessler, Lg" uniqKey="Kessler L">LG Kessler</name></author><author><name sortKey="Urban, N" uniqKey="Urban N">N Urban</name></author><author><name sortKey="Smucker, Rc" uniqKey="Smucker R">RC Smucker</name></author></analytic></biblStruct><biblStruct><analytic><author><name sortKey="Behm, Ec" uniqKey="Behm E">EC 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Renier</name></author><author><name sortKey="Racano, C" uniqKey="Racano C">C Racano</name></author><author><name sortKey="Carraro, P" uniqKey="Carraro P">P Carraro</name></author><author><name sortKey="Nitti, D" uniqKey="Nitti D">D Nitti</name></author><author><name sortKey="Givom, T" uniqKey="Givom T">T GIVOM</name></author></analytic></biblStruct></listBibl></div1></back></TEI></record>Pour manipuler ce document sous Unix (Dilib)
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