Cost Analysis of Transoral Surgery versus XRT for Early-Stage Glottic Cancer

Which treatment for Tis/T1 glottic carcinoma among adult patients, transoral CO2 laser excision (TOL) or external beam radiation (XRT), is superior in terms of cost utility?

Background: Cancer of the larynx is the most common head and neck cancer, with 75 percent of cases confined to the level of the glottis. The goal of treatment for this highly curable disease is to cure with the best achievable functional result, with no serious complications and in a cost-effective manner.

Study design: Literature review cost-utility analysis

Setting: Department of Otolaryngology-Head and Neck Surgery, University of Toronto, Ontario, Canada

Synopsis: Six head-to-head comparison studies and 22 consecutive case series were identified to examine oncologic control. Primary endpoints were local control (LC), laryngectomy-free survival (LFS) and overall survival (OS). Secondary endpoints were objective and subjective voice quality measures. Several methods were used in cost analysis. The researchers found no significant differences between TOL surgery and XRT with respect to LC, LFS and OS, and no objective differences for voice quality. CO2 laser excision cost $2407.32/case, generating 1.663 quality-adjusted life years (QALYs). Radiation cost $4828.79/case, generating 1.506 QALYs.

Bottom line: There is no clear difference in oncologic outcome between TOL surgery and XRT, but TOL surgery dominates XRT from a cost-utility standpoint.

Citation: Higgins KM. What treatment for early-stage glottic carcinoma among adult patients: CO2 endolaryngeal laser excision versus standard fractionated external beam radiation is superior in terms of cost utility? Laryngoscope. 2011;121:116-134.

—Reviewed by Sue Pondrom