Cost-Effectiveness of Hybrid PET/CT for Staging of Non–Small Cell Lung Cancer

Abstract

Although the diagnostic effectiveness of integrated PET/CT for staging of non-small cell lung cancer (NSCLC) has already been proven, it remains to be determined if tumor staging with combined metabolic and anatomic imaging is also cost-effective. The objective of this study was to evaluate from a payers' perspective the cost-effectiveness of staging NSCLC with CT alone (representing the mainstay diagnostic test) and with integrated PET/CT. Methods: The study is based on 172 NSCLC patients from a prospective clinical study who underwent diagnostic, contrast-enhanced helical CT and integrated PET/CT. Imaging was performed at the University Hospital Ulm between May 2002 and December 2004. To calculate treatment costs, we differentiated among cost for diagnosis, cost for nonsurgical treatment according to the clinical diagnosis, and cost for surgical procedures according to the clinical tumor stage. Results: The diagnostic effectiveness in terms of correct TNM staging was 40% (31/77) for CT alone and 60% (46/77) for PET/CT. For the assessment of resectability (tumor stages Ia-IIIa vs. IIIb-IV), 65 of 77 patients (84%) were staged correctly by PET/CT (CT alone, 70% [54/77]). The incremental cost-effectiveness ratios per correctly staged patient were $3,508 for PET/CT versus CT alone. The incremental cost-effectiveness ratios per quality-adjusted life year gained were $79,878 for PET/CT vs. CT alone, decreasing to $69,563 assuming a reduced loss of utility (0.10 quality-adjusted life years) due to surgical morbidity. Conclusion: Cost-effectiveness analyses showed that costs for PET/CT are within the commonly accepted range for diagnostic tests or therapies. Therefore, reimbursement of PET/CT for NSCLC staging can be also recommended from an economic point of view.

PET/CT for staging lung cancer: costly or cost-saving?

“…In our own study comprising 172 patients with an initial diagnosis of NSCLC, the ICER was in a similar range as reported by Søgaard et al (3,810 € per patient correctly staged as resectable vs non-resectable) [13]. In addition, a cost-utility analysis was performed.…”

PET-PANC: multicentre prospective diagnostic accuracy and health economic analysis study of the impact of combined modality 18fluorine-2-fluoro-2-deoxy-d-glucose positron emission tomography with computed tomography scanning in the diagnosis and management of pancreatic cancer

“…More research is needed as and when reliable data become available. Our inclusion criteria identified four studies [66][67][68][69] (see Appendix 6). Two of these were from the UK, 68,69 one was from Denmark 66 and one was from Germany.…”

“…Two of these were from the UK, 68,69 one was from Denmark 66 and one was from Germany. 67 One study was a cost-effectiveness analysis, 66 one was a cost-effectiveness and cost-utility analysis 67 and two were cost-utility analyses. 68,69 Two studies used decision-analytical models 68,69 and the other two used Cox proportional hazards and generated cost-effectiveness acceptability curves (CEACs).…”

Large Decreases in Standardized Uptake Values After Definitive Radiation Are Associated with Better Survival of Patients with Locally Advanced Non–Small Cell Lung Cancer

“…PET has had an increasing role in the initial staging and posttreatment evaluation of various types of cancer, including breast cancer, lymphoma, head and neck cancer, and NSCLC (2)(3)(4)(5)(6)(7)(8). The uptake of the glucose analog 18 F-FDG by NSCLC tumor cells has been found to be useful for restaging at recurrence and for delineating radiotherapeutic targets (9)(10)(11).…”