Preoperative staging of lung cancer with PET/CT: cost-effectiveness evaluation alongside a randomized controlled trial

Rikke Søgaard, Barbara Malene B Fischer, Jann Mortensen, Liselotte Højgaard, Ulrik Lassen

    35 Citations (Scopus)

    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.

    Original languageEnglish
    JournalEuropean Journal of Nuclear Medicine and Molecular Imaging
    Volume38
    Issue number5
    Pages (from-to)802-9
    Number of pages8
    ISSN1619-7070
    DOIs
    Publication statusPublished - May 2011

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