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Article Title

Using Systematic Review and Decision Modeling to Fill Gaps in Evidence: Application to Positron Emission Tomography Scan Use in Posttreatment Squamous Cell Carcinoma of the Oropharynx

Publication Date

4-30-2015

Keywords

systematic review, cancer

Abstract

Background/Aims: There is a general lack of cost-effectiveness evidence for positron emission tomography (PET) scan use in cancer suitable to support decision-making, and specifically for post-nonsurgical treatment of squamous cell carcinoma of the oropharynx (SCOOP). The value of effectiveness research is greatest when there are considerable data challenges and uncertainty due to early adoption of new technology and/or emerging serious high-growth disease. New expensive technology commonly becomes the standard of care without adequate evidence to support its value, including whether its performance does more good than harm to patients compared to the previous standard or alternatives. An example is the lack of evidence-informed standards for postchemoradiation imaging of SCOOP for patient management. The standard of care is posttreatment physical examination with imaging at 8–12 weeks using PET scan, computed tomography scan or ultrasound. Due to limits in the sensitivity and negative predictive value of these alternatives, patients may be over- or undertreated. A particular concern is PET scans are routinely used in practice although they have a high false-positive rate, which often result in unnecessary procedures.

Methods: A recommended efficient and evidence-based approach to providing needed information addressing health care cost and quality research gaps is decision and simulation modeling informed by a systematic review of the literature to obtain relevant information for model assumptions and parameter values augmented by expert input and consensus review. This approach will be applied to three posttreatment imaging alternatives for human papillomavirus (HPV)-positive SCOOP patients, and supplemented by Cancer Research Network (CRN) virtual data warehouse (VDW) patient data from HMORN participants and a technical expert panel from the newly formed CRN Head and Neck Cancer Scientific Interest Group.

Results: The results presented are a decision-analysis model with assumptions, parameters and input values documented from the systematic review, CRN VDW data and input provided by the CRN Head and Neck Cancer Scientific Interest Group.

Discussion: The finalized decision-analysis model will support simulations to estimate comparative effectiveness outcomes and cost-effectiveness of the HPV-positive SCOOP post-nonsurgical treatment imaging alternatives to provide much needed evidence to evaluate and improve clinical decision-making and patient outcomes and to identify future research needs.

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