# Sentinel Lymph‐Node Biopsy Guided Neck Dissection Versus Elective Neck Dissection in the Management of Early‐Stage Oral Cancer—A Cost‐Utility Analysis

## TL;DR

This study compares the cost-effectiveness of sentinel lymph node biopsy-guided neck dissection versus other methods for treating early oral cancer in India.

## Contribution

The study provides a cost-utility analysis of sentinel lymph node biopsy-guided neck dissection for early oral cancer in India.

## Key findings

- SLNB-guided neck dissection is cost-effective compared to elective neck dissection alone.
- SLNB has a 94% probability of being cost-effective at a GDP per capita threshold.
- The incremental cost per QALY for SLNB is below the GDP per capita threshold in India.

## Abstract

This study aims to assess the incremental cost per quality‐adjusted‐life‐year (QALY) gained in treating patients with early oral squamous cell carcinoma (OSCC) using sentinel lymph node biopsy (SLNB) guided neck dissection.

A Markov model was created to simulate disease‐free survival, recurrence, and overall survival in a hypothetical cohort of patients with early OSCC in India. Three groups were assessed: Group I—SLNB‐guided neck dissection, Group II—elective neck dissection (END) alone, and Group III—END with frozen section (FS). Costs and QALY were assessed using a payer's perspective, lifetime horizon, and 3% discount, and incremental cost utility ratios (ICUR) were computed. Interventions with ICUR less than one‐time gross domestic product (GDP) per capita were considered cost‐effective. Both one‐way and probabilistic‐sensitivity analyses were conducted to examine model uncertainty.

In comparison to Group II and Group III, Group I incurs additional costs of INR 5564 (US$ 67) and INR 2507 (US$ 30) per patient, respectively, and results in an incremental gain of 0.31 and 0.33 additional QALYs, respectively, over a lifetime horizon. The ICURs for Group I versus Group II and Group III are INR 8088 (US$ 97) and INR 16,709 (US$ 200), respectively. At a threshold of one‐time per‐capita GDP, SLNB demonstrates a 94% probability of being cost‐effective.

SLNB‐guided neck dissection is a cost‐effective strategy for management of early OSCC in India. Our findings support inclusion of SLNB‐guided neck dissection in the Indian Government's insurance program.