Abstract
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 €.
Results
The incremental cost of the PET/CT-based regimen was estimated at 3,927 € [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 €, which would be cost-effective at a probability of 0.90 given a willingness to pay of 50,000 € 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.
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Acknowledgement
The contribution to this study from all of the members in the PERALUST study group is respectfully acknowledged. The following colleagues contributed significantly to this project: S. Larsen from Hvidovre Hospital; A. Loft, AK. Bertelsen, J. Ravn, I. Steffensen and G. Jacobsen from Rigshospitalet, Copenhagen University Hospital, Copenhagen; P. Clementsen, A. Dirksen, P. Vilmann, N. Maltbæk and J. Pedersen from Gentofte Hospital, Copenhagen; A. Hoegholm from Næstved Hospital, Næstved; KR. Larsen, BG. Skov, H. Hansen, V. Backer and H. Nielsen from Bispebjerg Hospital, Copenhagen; TR. Rasmussen, S. Keiding and H. Madsen from Århus Hospital, Århus; O. Gerke, Odense University Hospital, Odense.
This work was funded by a grant from The Danish Cancer Society (application no. R2-A299-B239). Thank you to the John and Birthe Meyer Foundation for providing the PET/CT scanner.
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Søgaard, R., Fischer, B.M.B., Mortensen, J. et al. Preoperative staging of lung cancer with PET/CT: cost-effectiveness evaluation alongside a randomized controlled trial. Eur J Nucl Med Mol Imaging 38, 802–809 (2011). https://doi.org/10.1007/s00259-010-1703-y
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DOI: https://doi.org/10.1007/s00259-010-1703-y