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

Authors

  • Rikke Søgaard
    • Centre for Health Service Research and Technology AssessmentUniversity of Southern Denmark
    • Department for Clinical Physiology, Nuclear Medicine and PET, RigshospitaletCopenhagen University Hospital
    • Department of Clinical Physiology and Nuclear MedicineHvidovre Hospital
  • Jann Mortensen
    • Department for Clinical Physiology, Nuclear Medicine and PET, RigshospitaletCopenhagen University Hospital
    • Faculty of Health SciencesUniversity of Copenhagen
  • Liselotte Højgaard
    • Department for Clinical Physiology, Nuclear Medicine and PET, RigshospitaletCopenhagen University Hospital
    • Faculty of Health SciencesUniversity of Copenhagen
  • Ulrik Lassen
    • Department of Oncology, RigshospitaletCopenhagen University Hospital
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