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Cost-Effectiveness of Positron Emission Tomography in Breast Cancer

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Abstract

Purpose

In this study, we used quantitative decision tree modeling to assess the cost-effectiveness of a positron emission tomography (PET)-based management scenario for breast cancer in Canada.

Procedures

Two patient management scenarios were compared (with and without PET). A metaanalysis of studies for the accuracy of PET in staging breast cancer was conducted. Life expectancies were calculated. Management costs were determined from previous cost-effective analyses, management costs from our institutions, and recently published Canadian cost estimates of various procedures.

Results

A cost savings of $695 per person is expected for the PET strategy, with an increase in life expectancy (7.4 days), when compared with the non-PET strategy. This cost savings remained in favor of the PET strategy when subjected to a sensitivity analysis.

Conclusions

The use of a PET management strategy for the staging of breast cancer is expected to remain economically viable in Canada under various economic conditions.

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Authors and Affiliations

  1. Faculty of Medicine, Memorial University of Newfoundland, 108 Moss Heather, Dr., St. John's, Newfoundland, A1B 4S1, Canada

    J. Scott Sloka MD

  2. Division of Nuclear Medicine, Department of Medical Imaging, Health Care Corporation of St. John's, St. John's, Newfoundland, A1B 3V6, Canada

    Peter D. Hollett

  3. Division of Community Health, Memorial University of Newfoundland, St. John's, Newfoundland, A1B 3V6, Canada

    Maria Mathews

Authors
  1. J. Scott Sloka MD
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  2. Peter D. Hollett
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  3. Maria Mathews
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Correspondence to J. Scott Sloka MD.

Appendix

Appendix

In this study, the cost of capital equipment is discounted over the expected lifetime of the equipment by using a standard annuity formula, amortized over the equipment lifetime at an assumed interest rate of 6%. Estimated equipment costs are outlined in Table A. The estimated equipment lifetime for a positron tomograph is five years, and it is 10 years for a cyclotron installation [61].

For both a PET camera and a cyclotron, the estimated yearly operating cost is $1,625 K. Assuming that each PET installation operated at full potential on a one shift per day basis (seven patients per shift), there would be a yearly capacity for 1,750 cases. The total cost per case would be $1,625 K/1,750 cases = $929/case. Allowing for a physician remuneration of $100 per case (an estimate based on other modalities), the total cost per case is estimated to be $1,029. Capital acquisition, depreciation, and annual operating estimates were not included for CT because one CT study is performed per person in each strategy, and these costs cancel out when the two management strategies are compared. Overhead costs were not included in this analysis.

Table A PET camera capital and operating cost estimates
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Sloka, J.S., Hollett, P.D. & Mathews, M. Cost-Effectiveness of Positron Emission Tomography in Breast Cancer. Mol Imaging Biol 7, 351–360 (2005). https://doi.org/10.1007/s11307-005-0012-5

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