Sentinel lymph node biopsy at the time of hysterectomy for early-stage cervical cancer: A cost-effectiveness analysis

Abstract

Objective

Standard management of early-stage cervical cancer is hysterectomy with bilateral pelvic lymph node evaluation. Based on the final results of the prospective international SENTIX Trial, we sought to determine the cost-effectiveness (CE) of type of lymph node assessment for early-stage cervical cancer.

Methods

A decision analytic model was created using TreeAgePro 2023 software to evaluate the strategies of routine full lymph node dissection (LND) without para-aortic node dissection verses sentinel lymph node dissection (SNLD) at the time of hysterectomy. It was assumed that patients in the SLND group underwent unilateral or bilateral full LND in the event of unilateral or bilateral non-mapping, respectively. Outcomes included cost, quality adjusted life years (QALYs), perioperative complications, lymphedema, and recurrence 24 months after surgery. Univariate and probabilistic sensitivity analyses investigated the impact of the strategies.

Results

In a theoretical cohort of 1000 women, SLND was the dominate strategy resulting in 1804 QALYs, cost $28.54 M, and incremental cost-effectiveness ratio (ICER) -$83,693, compared to routine LND. This strategy resulted in 53 total peri-operative complications and a 77 % reduction in lymphedema cases. At 24 months, the recurrence rate was 62 in the SLND group and 89 in the full LND group, respectively.

Conclusions

Compared to routine full LND, SLND is CE with a reduction in post-operative complications and lymphedema with an ICER of -$83,693. When feasible, this surgical technique should be considered at the time of hysterectomy.