# Cost Analysis of Sentinel Lymph Node Biopsy for Oral Tongue Squamous Cell Carcinoma: Institutional Cohort and Population-Based Simulation

## TL;DR

This study compares the costs of sentinel lymph node biopsy and selective neck dissection for oral cancer, finding that the former can significantly reduce treatment costs.

## Contribution

The study introduces a novel cost analysis combining institutional data and population-based simulation for oral cancer treatment decisions.

## Key findings

- SLNB had significantly lower costs (R$4,943.67) compared to SND (R$11,005.49).
- SLNB adoption could reduce treatment costs by 27.93% to 66.54% based on population data.
- SLNB becomes more expensive than SND when occult metastasis rates exceed 72%.

## Abstract

In oral carcinoma patients classified as cN0, selective neck dissection (SND) and sentinel lymph node biopsy (SLNB) may be used to stage the neck with equivalent oncological results.

Compare the costs of SLNB and SND for oral squamous cell carcinoma.

Analysis of institutional cohort and Markov chain model simulation using populational data.

We included 84 patients submitted to transoral resection and SLNB or SND and patients submitted only to SND. The mean cost was R$4,943,67 for SLNB and R$ 11,005.49 for SND with significant differences in length of stay (one versus three days, p < 0.001), operative time (92 versus 177 minutes, p < 0.001) and postoperative hospital visits in 60 days (two versus eight, p < 0.001). For the simulation model, the probability of not finding the SLN ranged from 0.0% to 5.7% with 0.5% increments and the probability of occult neck metastasis ranged from 9.0% to 100.0% with 1% increments. The costs of SLNB increase progressively as the rate of occult neck metastasis increases. When this rate reaches 56%, the cost difference becomes not significant. With rates above 72%, SLNB becomes significantly more expensive than SND. Using a public database, we calculate a cost decrease ranging from 27.93% to 66.54% with SLNB adoption.

SLNB adoption may significantly decrease the costs associated with early-stage oral cancer treatment. It would allow more patients to be treated with the same number of resources now available.