Preoperative staging of lung cancer with PET/CT: cost-effectiveness evaluation alongside a randomized controlled trial
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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.
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 €.
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.
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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- Preoperative staging of lung cancer with PET/CT: cost-effectiveness evaluation alongside a randomized controlled trial
European Journal of Nuclear Medicine and Molecular Imaging
Volume 38, Issue 5 , pp 802-809
- Cover Date
- Print ISSN
- Online ISSN
- Additional Links
- Lung cancer staging
- Randomized controlled trial
- Industry Sectors
- Author Affiliations
- 1. Centre for Health Service Research and Technology Assessment, University of Southern Denmark, Copenhagen, Denmark
- 2. Department for Clinical Physiology, Nuclear Medicine and PET, Rigshospitalet, Copenhagen University Hospital, Copenhagen, Denmark
- 5. Department of Clinical Physiology and Nuclear Medicine, Hvidovre Hospital, Kettegård Allé 30, 2650, Hvidovre, Denmark
- 3. Faculty of Health Sciences, University of Copenhagen, Copenhagen, Denmark
- 4. Department of Oncology, Rigshospitalet, Copenhagen University Hospital, Copenhagen, Denmark