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 effective 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 diagnostic procedure, the primary treatment, the complications, and the salvage treatment were individualized. The charges of each of these events weighted for the frequency of occurrence were then determined using the 'fee for service' 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 case of positive margins (30%). For FL, the cost of the primary treatment accounted 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 less 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 analysis indicated that reduction of the duration of hospitalization decreases the costs without affecting the ranking between the three options. Also, the cost of L could be reduced even slightly below the cost of RT by decreasing the need for post-operative RT. Conclusions: RT and L have almost the same expected average cost for the treatment of T1N0 glottic SCC, whereas PL is twice as expensive. (C) 1999 Elsevier Science Ireland Ltd. All rights reserved.