What treatment for early‐stage glottic carcinoma among adult patients: CO<sub>2</sub> endolaryngeal laser excision versus standard fractionated external beam radiation is superior in terms of cost utility?
Bibliographic record
Abstract
OBJECTIVES/HYPOTHESIS: To determine which treatment for Tis/T1 glottic carcinoma among adult patients, transoral CO(2) laser excision (TOL) versus external beam radiation (XRT), is superior in terms of cost utility. STUDY DESIGN: Cost-utility analysis. METHODS: Six head-to-head comparison studies and 22 consecutive case series were identified to examine oncologic control. The case series were pooled as a composite group. Primary end points were local control (LC), laryngectomy-free survival (LFS), and overall survival (OS). Objective and subjective voice-quality measures were secondary end points. Third-party payer perspective was adopted for cost-utility analysis. Operational and capital costs were determined with the microcosting method. Rollback calculations and quality adjusted life years (QALYs) were calculated with decision-tree modeling. RESULTS: There were no significant differences between TOL surgery and XRT with respect to LC (odds ratio [OR], 0.81; 95% confidence interval [CI], 0.51-1.3) and LFS (OR, 0.84, 95% CI, 0.42-1.66). The weighted mean difference for OS was 0.03. There were no objective differences for measures of voice quality. Decision-tree analysis was undertaken using mean 5-year local control initial probabilities. CO(2) laser cost $2475.65/case (US $2407.32/case), generating 1.663 QALYs, whereas radiation cost $4965.85/case (US $4828.79/case), generating 1.506 QALYs. This contrasts initial upstream costs for CO(2) laser (∼$1889/case, ∼US $1836.86/case) and radiation (∼$2454.70/case, ∼US $2386.95/case). CONCLUSIONS: This meta-analysis shows that there is no clear difference in oncologic outcome between TOL surgery and XRT. There is a trend for improved post-treatment voice quality with XRT, although the clinical significance of this is questionable. TOL surgery dominates XRT from a cost-utility standpoint primarily because of the enhanced downstream affordability of salvage treatment.
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How this classification was reachedexpand
Full frame machine prediction
Teacher imitationNot calibrated prevalence, not ground truth. Human validation pending. The Gemma side is a direct model label for every work in the frame, read from the title-only record. The Codex side is a classifier learned from the 10,348 direct Codex labels and calibrated to design-weighted sample rates; fields without enough sample support carry no Codex call. Candidate is the union of the two sides; consensus is their intersection. These outputs are machine_predicted_unvalidated and are not human labels.
Distilled classifier scores by category (both heads)
| Category | Codex | Gemma |
|---|---|---|
| Metaresearch | 0.004 | 0.011 |
| Meta-epidemiology (narrow) | 0.000 | 0.000 |
| Meta-epidemiology (broad) | 0.001 | 0.002 |
| Bibliometrics | 0.001 | 0.001 |
| Science and technology studies | 0.000 | 0.001 |
| Scholarly communication | 0.001 | 0.001 |
| Open science | 0.000 | 0.000 |
| Research integrity | 0.001 | 0.000 |
| Insufficient payload (model declined to judge) | 0.002 | 0.000 |
Machine scores (provisional)
The two teacher heads of the student model, read on this work. A score orders the frame for review; it never asserts a category, and the validation status ships verbatim with every row.
Baseline scores from an immature model (maturity gate not passed, 7 training rounds). Scores rank; they never assert a category.
score_only:v0-immature-baseline · verbatim from the scoring run: score_only means the number may rank works, and no category label ships from itClassification
machine, unvalidatedMachine predicted; a candidate call from one source (direct Gemma or distilled Codex), not a consensus.
How this classification was reached, model by model and score by score, is at the end of the page under "How this classification was reached".