title: Analytical decision model for the cost-effective management of solitary pulmonary nodules.
abstract: 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.
authors.affiliation: Crump Institute for Biological Imaging, University of California Los Angeles School of Medicine 90095-1770, USA. sgambhir@mednet.ucla.edu
authors.forename: S S
authors.initials: SS
authors.lastname: Gambhir
authors.forename: J E
authors.initials: JE
authors.lastname: Shepherd
authors.forename: B D
authors.initials: BD
authors.lastname: Shah
authors.forename: E
authors.initials: E
authors.lastname: Hart
authors.forename: C K
authors.initials: CK
authors.lastname: Hoh
authors.forename: P E
authors.initials: PE
authors.lastname: Valk
authors.forename: T
authors.initials: T
authors.lastname: Emi
authors.forename: M E
authors.initials: ME
authors.lastname: Phelps
mesh_terms: 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