Cost-minimization analysis of treatment options for T1N0 glottic squamous cell carcinoma: comparison between external radiotherapy, laser microsurgery and partial laryngectomy

Background and purpose: A cost minimization analysis of radiotherapy (RT), laser microsurgery (L) or partial laryngectomy (PL), which are equally effe ctive options for T1N0 glottic SCC was carried out from the perspective of the National Health Care System. Methods: For each modality, the various events associated with the diagnost ic procedure, the primary treatment, the complications, and the salvage tre atment were individualized. The charges of each of these events weighted fo r the frequency of occurrence were then determined using the 'fee for servi ce' policy established by the National Health Insurance of Belgium. Results: A total cost of 5172, 5847 and 11563 EURO were calculated for RT, L and FL, respectively, For L, cost included post-operative RT applied in c ase of positive margins (30%). For FL, the cost of the primary treatment ac counted for 68% of the total cost whereas it only accounted for 50 and 43% for L and RT, respectively. For RT, L or FL, complications accounted for le ss than 10% of the total cost. The cost of salvage treatment reached 19, 14 and 8% of the total cost for RT, L and FL, respectively. A sensitivity ana lysis indicated that reduction of the duration of hospitalization decreases the costs without affecting the ranking between the three options. Also, t he cost of L could be reduced even slightly below the cost of RT by decreas ing the need for post-operative RT. Conclusions: RT and L have almost the same expected average cost for the tr eatment of T1N0 glottic SCC, whereas PL is twice as expensive. (C) 1999 Els evier Science Ireland Ltd. All rights reserved.