Elsevier

The Annals of Thoracic Surgery

Volume 66, Issue 6, December 1998, Pages 1876-1884
The Annals of Thoracic Surgery

Original Articles
Cost-effectiveness of FDG-PET for staging non–small cell lung cancer: a decision analysis

Presented at the Thirty-fourth Annual Meeting of The Society of Thoracic Surgeons, New Orleans, LA, Jan 26–28, 1998.
https://doi.org/10.1016/S0003-4975(98)01055-8Get rights and content

Abstract

Background. Preliminary studies have shown that thoracic positron emission tomography (PET) is more accurate than thoracic computed tomography (CT) for the staging of non–small cell lung carcinoma. In the present study the cost-effectiveness, as measured by national Medicare reimbursed costs, and patient life expectancy are used to compare several thoracic PET-based strategies with a conventional thoracic CT-based strategy for preoperative staging.

Methods. Five decision strategies for selection of potential surgical candidates were compared; thoracic CT alone or four different strategies that use thoracic CT plus thoracic PET. The various paths of each strategy are dependent on numerous variables that were determined from a review of the medical literature. Life expectancy was calculated using the declining exponential approximation of life expectancy and reduced on the basis of procedural morbidity and mortality. Costs were based on national Medicare reimbursed costs. For all possible outcomes of each strategy, the expected cost and projected life expectancy were determined. The effects of changing one or more variables on the expected cost and life expectancy were studied using sensitivity analysis.

Results. A strategy that uses PET only after a negative CT study is shown to be a cost-effective alternative to the CT-alone strategy ($25,286 per life-year saved).

Conclusions. These results show through rigorous decision tree analysis the potential cost-effectiveness of using thoracic PET in the management of non–small cell lung carcinoma. Greater use of thoracic PET for non–small cell lung carcinoma staging is warranted, and further clinical trials should help to validate the analytic results predicted from this study.

Section snippets

Material and methods

Decision tree models were constructed with four competing strategies (one with thoracic CT alone and three that included both thoracic CT and thoracic PET). To each possible outcome of each strategy, estimated national reimbursed Medicare costs and patient life expectancy were assigned. The explicit probabilities of each outcome in the tree were obtained as a function of the variables shown in Table 1. These probabilities were computed using simple Bayesian analysis 7, 8. Multiple decision

Results

Shown in the first row of Table 5are the results of cost, life expectancy, and ICER for baseline estimates of all variables for strategies A to D. The ICER compares the cost of additional life for each of strategies B, C, and D with that for strategy A. A negative ICER value (values shown in parenthesis) indicates a dominance of the alternative strategy over strategy A (both lower cost and higher life expectancy). Table 5 indicates that strategy B is the most cost-effective strategy based on a

Comment

The results of the current investigation support the use of thoracic PET as an adjunct to thoracic CT for preoperative staging. A strategy that requires performance of a PET study only after negative CT results was shown to be most cost-effective compared with the current CT-only management strategy. Regardless of the exact option taken, a role for thoracic PET seems highly likely. Even under a wide range of assumptions, thoracic PET identifies a significant number of patients with mediastinal

Acknowledgements

This work was partially supported by funding from the Laubisch Foundation and the Ahmanson Foundation, with grants awarded to Dr. Gambhir.

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