Table 1.
Model inputs for the base case and sensitivity analyses from the payer and societal perspectives
|
| ||||
|---|---|---|---|---|
| Input Variable | Base Case | Range | Distribution | Source |
|
| ||||
| Sex | Female | NA | NA | N/A |
| Age | 70 | 60–90 | Triangular | 5,6,7 |
| Time Horizon | 15 years | 10–25 years | NA | 5 |
| Discount Rate | 3% | NA | NA | 11 |
| Probabilities | ||||
| High burden disease | 0.071 | 0.010–0.100 | Beta | 5,7 |
| Low burden disease | 0.183 | 0.050–0.500 | Beta | 5,7 |
| No axillary disease | 0.746 | 0.600–0.900 | Beta | 5,7 |
| Probability of sentinel node non-detection | 0.010 | 0.000–0.100 | Beta | 49 |
| Lymphedema after SLNB | 0.057 | 0.010–0.200 | Beta | 28,29,30 |
| Lymphedema after ALND | 0.140 | 0.050–0.300 | Beta | 28,29,30 |
| LRR with no axillary evaluation | 0.008 | 0.006–0.010 | Beta | 5,6,7 |
| DMR with no axillary evaluation | 0.010 | 0.009–0.011 | Beta | 5,6,7 |
| LRR with no positive SLNs | 0.003 | 0.002–0.006 | Beta | 13,14 |
| DMR with no positive SLNs | 0.007 | 0.006–0.009 | Beta | 13,14 |
| LRR with 1–2 positive SLNs | 0.004 | 0.003–0.007 | Beta | 10,15,16 |
| DMR with 1–2 positive SLNs | 0.008 | 0.005–0.009 | Beta | 10,15,16 |
| LRR with > 2 positive SLNs | 0.011 | 0.009–0.013 | Beta | 18,19 |
| DMR with > 2 positive SLNs | 0.064 | 0.020–0.080 | Beta | 18,19 |
| DMR after LRR | 0.146 | 0.050–0.250 | Beta | 21 |
| Cancer specific mortality after DMR | 0.320 | 0.200–0.500 | Beta | 23,24 |
| Cancer specific mortality after LRR | 0.048 | 0.030–0.060 | Beta | 22,25,26 |
| All-cause mortality | Varies by age | N/A | Table | 27 |
| Health State Utilities | ||||
| Disease-free | 0.977 | 0.800–1.00 | Beta | 39,40 |
| LRR, year 1 | 0.836 | 0.700–0.950 | Beta | 39,40 |
| LRR, after year 1 | 0.878 | 0.750–0.975 | Beta | 39,40 |
| DMR, annual | 0.719 | 0.600–0.800 | Beta | 39,40 |
| Disutility Estimates | ||||
| Age-related quality of life | Variable | 0.820–0.900 | N/A | 42 |
| Adjuvant radiation or chemotherapy | 0.30 | 0.100–0.400 | Beta | 50 |
| Lymphedema | 0.20 | 0.150–0.300 | Beta | 41 |
| Costs | ||||
| Injection for SLNB | $88 | $25-$200 | Gamma | 31,32 |
| SLNB | $6,937 | $3,000-$10,000 | Gamma | 31,32 |
| ALND | $7,948 | $4,000-$11,000 | Gamma | 31,32 |
| LR recurrence, year 1 | $8,247 | $5,000-$12,000 | Gamma | 34 |
| LR recurrence, after year 1 | Variable | NA | NA | 34 |
| Distant metastases | $6,790 | $3,000-$10,000 | Gamma | 34 |
| Adjuvant chemotherapy | $12,394 | $5,164-$18,590 | Gamma | 31,33 |
| Adjuvant axillary radiation | $14,000 | $5,500–20,000 | Gamma | 31,33 |
| Lymphedema, year 1 | $2,268 | $500-$5,000 | Gamma | 33 |
| Lymphedema, after year 1 | $1,465 | $250-$2,500 | Gamma | 33 |
| Costs, Societal Perspective Only | ||||
| Travel for Lymphedema treatment, year 1 | $24 | $30–55 | Gamma | 35,36 |
| Travel for lymphedema, treatment, after year 1 | $22 | $18–42 | Gamma | 35,36 |
| Informal caregiver costs for LR recurrence, year 1 | $4,200 | $2,000-$6,000 | Gamma | 37 |
| Informal caregiver costs for LR recurrence, after year 1 | $2,900 | $1,000-$5,000 | Gamma | 37 |
| Informal caregiver costs for DMR | $4,200 | $2,000-$6,000 | Gamma | 37 |
SLNB = sentinel lymph node biopsy, ALND = axillary lymph node dissection, SLNs = sentinel lymph nodes, LRR = locoregional recurrence, DMR = distant metastatic recurrence