Lymphatic mapping and sentinel lymph node dissection compared to complete lymphadenectomy in the management of XXXX : A cost-utility analysis.

@entity1 @entity4269 @entity1600 @entity5
OBJECTIVE: @entity1600 ( @entity1600 ) is an acceptable method of evaluating groin lymph nodes in @entity1 with @entity5 . The purpose of this study is to assess the cost and effectiveness of @entity1600 compared to universal inguinofemoral lymphadenectomy (LND) for @entity5 . METHODS: A modified Markov decision model was generated to compare two surgical approaches for newly diagnosed, @entity5 : (1) radical vulvectomy+LND and (2) radical vulvectomy+ @entity1600 . Published data were used to estimate survival outcomes, probability of positive lymph nodes and @entity4269 . Costs of surgery and radiation and @entity4269 therapies were estimated from published data. @entity4269 's effect on quality of life (QOL) was extrapolated from other disease sites and assigned a utility score of 0.84. Multiple sensitivity analyses were performed. RESULTS: @entity1600 was less costly ( 13,449 versus  14,261) and more effective (4.16 quality-adjusted life years (QALYs) versus 4.00 QALYs) than LND. The model was sensitive to the impact of @entity4269 on QOL. Unless the impact of @entity4269 on QOL was minimal (utility score>0.975) @entity1600 dominated LND. Variations in the rate of positive @entity1600 and probability of @entity4269 over clinically reasonable ranges did not alter the results. CONCLUSIONS: @entity1600 is a cost-effective strategy for the treatment of newly diagnosed @entity5 , mainly due to the impact of @entity4269 on QOL.
