European Journal of Nuclear Medicine and Molecular Imaging

, Volume 38, Issue 5, pp 802–809

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
Original Article

DOI: 10.1007/s00259-010-1703-y

Cite this article as:
Søgaard, R., Fischer, B.M.B., Mortensen, J. et al. Eur J Nucl Med Mol Imaging (2011) 38: 802. doi:10.1007/s00259-010-1703-y

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.

Keywords

PET/CTCost-effectivenessLung cancer stagingRandomized controlled trial

Copyright information

© Springer-Verlag 2010

Authors and Affiliations

  • Rikke Søgaard
    • 1
  • Barbara Malene B. Fischer
    • 2
    • 5
  • Jann Mortensen
    • 2
    • 3
  • Liselotte Højgaard
    • 2
    • 3
  • Ulrik Lassen
    • 4
  1. 1.Centre for Health Service Research and Technology AssessmentUniversity of Southern DenmarkCopenhagenDenmark
  2. 2.Department for Clinical Physiology, Nuclear Medicine and PET, RigshospitaletCopenhagen University HospitalCopenhagenDenmark
  3. 3.Faculty of Health SciencesUniversity of CopenhagenCopenhagenDenmark
  4. 4.Department of Oncology, RigshospitaletCopenhagen University HospitalCopenhagenDenmark
  5. 5.Department of Clinical Physiology and Nuclear MedicineHvidovre HospitalHvidovreDenmark