Original ArticlesCost-effectiveness of FDG-PET for staging non–small cell lung cancer: a decision analysis
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.
References (24)
- et al.
Mediastinal lymph node staging of non-small cell lung cancera prospective comparison of computed tomography and positron emission tomography
J Thorac Cardiovasc Surg
(1996) - et al.
Positron emission tomography of lung tumors and mediastinal lymph nodes using [18F]fluorodeoxyglucose
Ann Thorac Surg
(1994) - et al.
Modern thirty-day operative mortality for surgical resection in lung cancer
J Thorac Cardiovasc Surg
(1983) - et al.
Lymph node staging in non-small cell lung cancerevaluation by [18F] FDG positron emission tomography (PET)
Thorax
(1997) - et al.
Staging of the mediastinumvalue of positron emission tomography imaging in non-small cell lung cancer
Eur Respir J
(1996) - et al.
Staging non-small cell lung cancer by whole-body positron emission tomographic imaging
Ann Thorac Surg
(1995) - et al.
Decision tree sensitivity analysis for cost-effectiveness of FDG-PET in the staging and management of non-small cell carcinoma
J Nucl Med
(1996) - et al.
Decision analysis
- et al.
Clinical decision analysis
(1980) - et al.
Medical decision analysis toola new physician friendly decision tree tool
MD Computing
(1998)
Prospective evaluation of mediastinoscopy for assessment of carcinoma of the lung
J Thorac Cardiovasc Surg
Bronchogenic carcinoma metastatic to normal-sized lymph nodesfrequency and significance
Radiology
Cited by (130)
Absence of clinical benefit of FDG PET-CT in staging T1 part-solid lung adenocarcinoma
2022, Clinical RadiologyCitation Excerpt :These recommendations stem, in part, from studies demonstrating that PET-CT is cost-effective prior to radical treatment in lung cancer.27,28 It is important to recognise that the seminal paper demonstrating the cost-effectiveness of PET (not PET-CT) prior to radical treatment in lung cancer was published in 1998,27 and a later study on the cost-effectiveness of PET-CT was published in 201028; however, more widespread radiological recognition of indolent sub-solid lung adenocarcinoma spectrum lesions occurred later, with an important publication on this disease occurring in 2011.3 It is therefore very likely that the cost effectiveness analyses published in 1998 and 2010 had a much lower proportion of these types of lung cancers than are currently being diagnosed and treated.
Systematic review of the cost-effectiveness of positron-emission tomography in staging of non-small-cell lung cancer and management of solitary pulmonary nodules
2012, Clinical Lung CancerCitation Excerpt :All studies used some form of sensitivity analysis (one-way, two-way, probabilistic, scenario analysis) to determine the impact of changes in key parameter values. Thirteen studies10-22 were focused on the use of PET imaging in the context of staging NSCLC and 5 studies9,23-26 focused on the management of indeterminate SPNs. A detailed analysis of the abstraction data and summary of the study conclusions for selected NSCLC studies are included in Tables 1 and 2, respectively; and for selected SPN studies in Tables 3 and 4, respectively.
The Use and Misuse of Positron Emission Tomography in Lung Cancer Evaluation
2011, Clinics in Chest MedicineCitation Excerpt :One early study compared conventional staging with CT and mediastinoscopy to conventional staging plus PET and found that PET-based staging reduced costs by $1154 per patient and increased life expectancy by 3 days.38 Another analysis reported that compared with CT followed by selective mediastinoscopy, a strategy of CT followed by mediastinoscopy (when CT showed enlarged lymph nodes) or PET (when there were no enlarged lymph nodes) cost approximately $25,000 per life-year gained.39 Another modeling study compared mediastinoscopy alone with PET followed by selective mediastinoscopy and found that for every 100 patients treated, PET plus selective mediastinoscopy resulted in seven fewer futile thoracotomies and saved $212,800 Australian dollars.40
Proposal of a diagnostic algorithm for lung cancer using (18)F-FDG PET
2009, Revista Espanola de Medicina NuclearAssessing short-term effects and costs at an early stage of innovation: The use of positron emission tomography on radiotherapy treatment decision making
2008, International Journal of Technology Assessment in Health Care