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?
Why this work is in the frame
A frame that forgets how it found something cannot be audited. These are the routes that admitted this work.
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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Full frame distilled prediction
Teacher imitationNot calibrated prevalence, not ground truth. Human validation pending. Learned from the 10,348 direct Codex labels and 10,348 direct Gemma labels. Candidate is the union of thresholded teacher heads; consensus is their intersection. These outputs are machine_predicted_unvalidated and are not human labels or direct frontier model labels.
Codex and Gemma teacher scores by category
| Category | Codex | Gemma |
|---|---|---|
| Metaresearch | 0.000 | 0.000 |
| Meta-epidemiology (narrow) | 0.001 | 0.000 |
| Meta-epidemiology (broad) | 0.002 | 0.001 |
| Bibliometrics | 0.000 | 0.000 |
| Science and technology studies | 0.000 | 0.000 |
| Scholarly communication | 0.000 | 0.000 |
| Open science | 0.000 | 0.000 |
| Research integrity | 0.000 | 0.001 |
| Insufficient payload (model declined to judge) | 0.000 | 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 it