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Transoral laser microsurgery versus radiation therapy in the management of T1 and T2 laryngeal glottic carcinoma: which modality is cost-effective within the UK?

Lookup NU author(s): Professor Vinidh Paleri



This is the authors' accepted manuscript of an article that has been published in its final definitive form by Blackwell Publishing Ltd, 2017.

For re-use rights please refer to the publisher's terms and conditions.


© 2017 John Wiley & Sons Ltd Objectives: To identify the most cost-effective treatment strategy in patients with early stage (T1 and T2) cancers of the laryngeal glottis. Design: A Markov decision model populated using data from updated systematic reviews and meta-analyses, with attributable costs from NHS sources. Data on local control and mortality were obtained from updates of existing systematic reviews conducted for the NICE guideline on cancer of the upper aerodigestive tract. Procedure costs were sourced from NHS reference costs 2013/14 by applying tariffs associated with the appropriate health resource group code. Setting: The UK National Health Service. Population: Patients with early stage (T1 and T2) cancers of the laryngeal glottis. Interventions: Transoral laser microsurgery (TLM) and radiation therapy (RT). Main outcome measures: Total costs, incremental costs and quality adjusted life years (QALYs) over a 10-year time horizon. Results: Radiation therapy as the initial treatment strategy was found to be more expensive (£2654 versus £623) and less effective (QALY reduction of 0.141 and 0.04 in T1a and T1b–T2 laryngeal cancers, respectively) than TLM. The dominance of TLM for T1a cancers was unchanged in most scenarios modelled in sensitivity analysis. For T1b–T2 laryngeal cancers, the result changed in numerous scenarios. In probabilistic sensitivity analysis, TLM was found to have a 71% and 58% probability of being cost-effective in T1a and T1b–T2 laryngeal cancers, respectively. Conclusions: Transoral laser microsurgery is a cost-effective strategy to adopt in the management of T1a laryngeal cancers. Uncertainty remains over the optimal strategy to adopt in T1b–T2 laryngeal cancers.

Publication metadata

Author(s): Prettyjohns M, Winter S, Kerawala C, Paleri V

Publication type: Article

Publication status: Published

Journal: Clinical Otolaryngology

Year: 2017

Volume: 42

Issue: 2

Pages: 404-415

Print publication date: 01/04/2017

Online publication date: 14/12/2016

Acceptance date: 05/12/2016

Date deposited: 27/04/2017

ISSN (print): 1749-4478

ISSN (electronic): 1749-4486

Publisher: Blackwell Publishing Ltd


DOI: 10.1111/coa.12807


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