Preoperative staging of lung cancer with PET/CT: cost-effectiveness evaluation alongside a randomized controlled trial
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PURPOSE: Positron emission tomography (PET)/CT has become a widely used technology for preoperative staging of non-small cell lung cancer (NSCLC). Two recent randomized controlled trials (RCT) have established its efficacy over conventional staging, but no studies have assessed its cost-effectiveness. The objective of this study was to assess the cost-effectiveness of PET/CT as an adjunct to conventional workup for preoperative staging of NSCLC.
METHODS: The study was conducted alongside an RCT in which 189 patients were allocated to conventional staging (n = 91) or conventional staging + PET/CT (n = 98) and followed for 1 year after which the numbers of futile thoracotomies in each group were monitored. A full health care sector perspective was adapted for costing resource use. The outcome parameter was defined as the number needed to treat (NNT)-here number of PET/CT scans needed-to avoid one futile thoracotomy. All monetary estimates were inflated to 2010 <euro>.
RESULTS: The incremental cost of the PET/CT-based regimen was estimated at 3,927 <euro> [95% confidence interval (CI) -3,331; 10,586] and the NNT at 4.92 (95% CI 3.00; 13.62). These resulted in an average incremental cost-effectiveness ratio of 19,314 <euro>, which would be cost-effective at a probability of 0.90 given a willingness to pay of 50,000 <euro> per avoided futile thoracotomy. When costs of comorbidity-related hospital services were excluded, the PET/CT regimen appeared dominant.
CONCLUSION: Applying a full health care sector perspective, the cost-effectiveness of PET/CT for staging NSCLC seems to depend on the willingness to pay in order to avoid a futile thoracotomy. However, given that four outliers in terms of extreme comorbidity were all randomized to the PET/CT arm, there is uncertainty about the conclusion. When hospital costs of comorbidity were excluded, the PET/CT regimen was found to be both more accurate and cost saving.
|Journal||European Journal of Nuclear Medicine and Molecular Imaging|
|Number of pages||8|
|Publication status||Published - May 2011|
- Adolescent, Adult, Aged, Aged, 80 and over, Cost-Benefit Analysis, Female, Humans, Lung Neoplasms, Male, Middle Aged, Neoplasm Staging, Positron-Emission Tomography, Preoperative Period, Sensitivity and Specificity, Tomography, X-Ray Computed, Young Adult, Journal Article, Randomized Controlled Trial, Research Support, Non-U.S. Gov't