, Volume 16, Issue 10, pp 2962-2963
Date: 14 Jul 2009

In Reply: Cost-Effectiveness of Sentinel Node Biopsy for Melanoma

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TO THE EDITORS:

Dr. Thomas suggests that the calculations made in our evaluation of the cost-effectiveness of sentinel node biopsy (SNB) depend entirely on the accuracy of the 20% survival difference reported in the third interim analysis of MSLT-I.1 This claim is not correct. The survival difference in life-years was not derived from a comparison of the two subgroups of node-positive patients but from comparison of the two randomized cohorts, i.e., from the total trial population (Fig. A, p. 932).1 Furthermore, the results of the economic evaluation were driven by three other factors: (1) higher disease-free survival at 5 years in the entire group of patients who had a sentinel node biopsy (SNB); (2) the lower complication rate (and resulting better quality of life) in the node-positive patients who had an immediate complete lymph node dissection (CLND) compared with those who later developed palpable nodal recurrence and had a delayed CLND; and (3) lower costs associated with an immed