CHICAGO–PET-CT guided active surveillance in patients with locally advanced head and neck squamous cell cancer (HSNCC) compared with node dissection is cost-effective over a short time horizon, data presented at the 2015 American Society of Clinical Oncology (ASCO) annual meeting have shown.

For the analysis, researchers analyzed the cost-effectiveness of the PET-NECK study that evaluated 564 patients with locally advanced nodal metastases of HNSCC receiving chemoradiotherapy and eligible for node dissection. Patients in that study were randomly assigned them 1:1 to undergo planned node dissection before or after chemoradiotherapy (control) or chemoradiotherapy followed 10 to 12 weeks by FDG-PET-CT with node dissection only if PET-CT demonstrated incomplete or equivocal response of nodal disease.

Result of the cost analysis showed that PET-CT guided surveillance produced an average per-person cost savings of £1,415 (95% CI: -607, -2,218) and a health gain of 0.07 QALYs (95% CI: -0.04, 0.19) compared with planned node dissection.

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“At a £20,000 per QALY threshold, PET-CT guided management is associated with a 99% probability of being cost saving and a 91% probability of being more cost-effective than planned node dissection,” said Alison Smith, Research Fellow at the Leeds Institute of Health Sciences in the United Kingdom.

However, in a lifetime cost-effectiveness model, the study showed that PET-CT guided management is associated with only a 50% probability of being cost-effective compared with planned node dissection.

The findings suggest that PET-CT surveillance is cost-effective over the trial period of about 3 years.

“The results of the within-trial cost-effectiveness analysis clearly support the findings of the trial effectiveness analysis,” Smith concluded. “The long-term impact of this strategy is uncertain. Further exploration of key model parameters and assumptions, especially regarding long-term recurrence, is required in order to determine the necessity for further research.”


1. Smith AF, Hall P, Hulme C, et al. Is PET-CT guided management for patients with locally advanced head and neck squamous cell cancer (HNSCC) cost-effective? Results from a UK non-inferiority phase III randomized trial.

J Clin Oncol. 2015;33:(suppl; abstr 6010).