Cost-effectiveness analyses demonstrate that observation is superior to sentinel lymph node biopsy for postmenopausal women with HR + breast cancer and negative axillary ultrasound

Aubriana M. McEvoy, Steven Poplack, Katelin Nickel, Margaret A. Olsen, Foluso Ademuyiwa, Imran Zoberi, Elizabeth Odom, Jennifer Yu, Su Hsin Chang, William E. Gillanders

Research output: Contribution to journalReview articlepeer-review

Abstract

Purpose: To evaluate the cost-effectiveness of axillary observation versus sentinel lymph node biopsy (SLNB) after negative axillary ultrasound (AUS). In patients with clinical T1-T2 N0 breast cancer and negative AUS, SLNB is the current standard of care for axillary staging. However, SLNB is costly, invasive, decreasing in importance for medical decision-making, and is not considered therapeutic. Observation alone is currently being evaluated in randomized clinical trials, and is thought to be non-inferior to SLNB for patients with negative AUS. Methods: We performed cost-effectiveness analyses of observation versus SLNB after negative AUS in postmenopausal women with clinical T1-T2 N0, HR+/HER2 breast cancer. Costs at the 2016 price level were evaluated from a third-party commercial payer perspective using the MarketScan® Database. We compared cost, quality-adjusted life years (QALYs), and net monetary benefit (NMB). Multiple sensitivity analyses varying baseline probabilities, costs, utilities, and willingness-to-pay thresholds were performed. Results: Observation was superior to SLNB for patients with N0 and N1 disease, and for the entire patient population (NMB in US$: $655,659 for observation versus $641,778 for SLNB for the entire patient population). In the N0 and N1 groups, observation incurred lower cost and was associated with greater QALYs. SLNB was superior for patients with > 3 positive lymph nodes, representing approximately 5% of the population. Sensitivity analyses consistently demonstrated that observation is the optimal strategy for AUS-negative patients. Conclusion: Considering both cost and effectiveness, observation is superior to SLNB in postmenopausal women with cT1-T2 N0, HR+/HER2 breast cancer and negative AUS.

Original languageEnglish
Pages (from-to)251-262
Number of pages12
JournalBreast Cancer Research and Treatment
Volume183
Issue number2
DOIs
StatePublished - Sep 1 2020

Keywords

  • Axilla
  • Breast cancer
  • Cost-effectiveness
  • Sentinel lymph node biopsy
  • Staging
  • Ultrasound

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