title: Solitary pulmonary nodules: accuracy and cost-effectiveness of sodium iodide FDG-PET using Australian data.
abstract: This study uses Australian data to confirm the accuracy of dedicated sodium iodide (NaI) fluorine-18 fluorodeoxyglucose positron emission tomography (FDG-PET) in evaluating indeterminate solitary pulmonary nodules (SPNs) and to determine the conditions under which PET could play a cost-effective role in this evaluation. Ninety-two patients from two Australian hospitals in different states underwent FDG-PET for evaluation of an SPN. Observed values for prior probability of malignancy and diagnostic accuracy of PET were applied to previously published decision tree models using published Australian health care costs. The accuracy of FDG-PET was 93% with a sensitivity of 92% and a specificity of 95%. The prior probability of malignancy (0.54), PET sensitivity and PET specificity indicated cost savings per patient of up to EUR 455 (Adollars 774) based on a PET cost of EUR 706 (Adollars 1,200). PET would remain cost-effective for levels of prior probability up to 0.8-0.9 and a PET cost of EUR 736-1,161 (Adollars 1,252-Adollars 1,974). It is concluded that NaI PET is accurate, cost saving and cost-effective for the characterisation of indeterminate pulmonary nodules in Australia. Comparison with previous reports from the United States confirms that FDG-PET can remain cost-effective despite population differences in medical costs, disease prevalence and PET diagnostic performance.
authors.affiliation: Southern X-ray Clinics, Wesley Hospital, Chasely St., Auchenflower, QLD 4006, Australia.
authors.forename: C J
authors.initials: CJ
authors.lastname: Keith
authors.forename: K A
authors.initials: KA
authors.lastname: Miles
authors.forename: M R
authors.initials: MR
authors.lastname: Griffiths
authors.forename: D
authors.initials: D
authors.lastname: Wong
authors.forename: A G
authors.initials: AG
authors.lastname: Pitman
authors.forename: R J
authors.initials: RJ
authors.lastname: Hicks
mesh_terms: D000368:Aged; D001315:Australia; D015331:Cohort Studies; D017046:Cost Savings; D003362:Cost-Benefit Analysis / Q000379:methods; D003663:Decision Trees; D005260:Female; D019788:Fluorodeoxyglucose F18 / Q000191:economics*; D006801:Humans; D008175:Lung Neoplasms / Q000175:diagnosis / Q000191:economics; D008297:Male; D008875:Middle Aged; D019275:Radiopharmaceuticals / Q000191:economics; D012189:Retrospective Studies; D012680:Sensitivity and Specificity; D003074:Solitary Pulmonary Nodule / Q000175:diagnosis / Q000000981:diagnostic imaging* / Q000191:economics*; D014055:Tomography, Emission-Computed / Q000191:economics*
chemical_list: D019275:Radiopharmaceuticals; D019788:Fluorodeoxyglucose F18