Analytical decision model for the cost-effective management of solitary pulmonary nodules.
OBJECTIVE
Multiple strategies are currently being used to manage patients who present with indeterminate solitary pulmonary nodules (SPN). We have used decision-analysis models to assess the cost-effectiveness of various strategies for the diagnosis and management of SPN. Four decision strategies were compared: a wait and watch strategy, a surgery strategy, a computed tomography (CT)-based strategy, and a CT-plus-positron emission tomography (PET) strategy. An incremental cost-effectiveness ratio (ICER) was used to compare all strategies to the wait and watch strategy.


RESULTS
A CT-plus-PET strategy was the most cost-effective over a large pretest likelihood (probability of having a malignant nodule), with a range of 0.12 to 0.69. Furthermore, within this likelihood range, the potential cost savings of using the CT-plus-PET strategy over the CT strategy ranged from $91 to $2,200 per patient. This translates to a yearly national savings of approximately $62.7 million.


CONCLUSIONS
Decision-analysis modeling indicates the potential cost-effectiveness of [18F]2-fluoro-2-deoxy-D-glucose (FDG)-PET in the management of SPN. Furthermore, the decision trees developed can be used to model various features of the management of SPN, including modeling the cost-effectiveness of other newly emerging technologies.
Gambhir
S S
SS
Crump Institute for Biological Imaging, University of California Los Angeles School of Medicine 90095-1770, USA. sgambhir@mednet.ucla.edu
Shepherd
J E
JE
Shah
B D
BD
Hart
E
E
Hoh
C K
CK
Valk
P E
PE
Emi
T
T
Phelps
M E
ME
D000328:Adult; D000368:Aged; D003362:Cost-Benefit Analysis; D003661:Decision Support Techniques; D019468:Disease Management; D005260:Female; D006801:Humans; D008017:Life Expectancy; D008175:Lung Neoplasms / Q000175:diagnosis* / Q000191:economics / Q000601:surgery; D008297:Male; D008875:Middle Aged; D014055:Tomography, Emission-Computed; D014057:Tomography, X-Ray Computed