Erschienen in:
01.10.2009 | Melanomas
In Reply: Cost-Effectiveness of Sentinel Node Biopsy for Melanoma
verfasst von:
John F. Thompson, MD, Rachael L. Morton, MScMed (Clin Epi) (Hons)
Erschienen in:
Annals of Surgical Oncology
|
Ausgabe 10/2009
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Excerpt
Dr. Thomas suggests that the calculations made in our evaluation of the cost-effectiveness of sentinel node biopsy (SNB) depend entirely on the accuracy of the 20% survival difference reported in the third interim analysis of MSLT-I.
1 This claim is not correct. The survival difference in life-years was not derived from a comparison of the two subgroups of node-positive patients but from comparison of the two randomized cohorts, i.e., from the total trial population (Fig. A, p. 932).
1 Furthermore, the results of the economic evaluation were driven by three other factors: (1) higher disease-free survival at 5 years in the entire group of patients who had a sentinel node biopsy (SNB); (2) the lower complication rate (and resulting better quality of life) in the node-positive patients who had an immediate complete lymph node dissection (CLND) compared with those who later developed palpable nodal recurrence and had a delayed CLND; and (3) lower costs associated with an immediate CLND. …
