Staging of non-small-cell lung cancer and application of FDG-PET. A cost modeling approach.
BACKGROUND
The presence of (distant) metastases affects the therapy (operation) and prognosis of patients with non-small-cell lung cancer (NSCLC). Fifty percent of the operations are futile due to the presence of a locally advanced tumor or distant metastases. Therefore, more accurate preoperative staging is required with respect to the outcomes (reduction of futile operations) and costs. This study examines current staging procedures and assesses possible situations for incorporating positron emission tomography (PET).


METHODS
A retrospective analysis was performed to assess actual clinical practice in the staging procedure of 337 patients with NSCLC in two Dutch hospitals. Consequently, by combining these data of actual clinical practice with a literature review, a model was developed to determine the influence of PET on the staging outcomes and the costs. In this model the accuracy and costs of PET can be varied as well as the extent of substitution of conventional diagnostic tests by PET.


RESULTS
Practice variation was found between the two hospitals with regard to the setting in which the diagnostic staging took place (hospitalization, outpatient setting) and the extent of the use of mediastinoscopy. This was reflected in the costs and in the number of (futile) operations.


CONCLUSIONS
Hospitalization is the major cost driver in these patients. From a cost viewpoint, the evaluation of PET in a strategy after diagnostic imaging but prior to invasive staging seems most optimal.
Verboom
Paul
P
Institute for Medical Technology Assessment, Erasmus University Rotterdam.
Herder
G Judith M
GJ
Hoekstra
Otto S
OS
Smit
Egbert F
EF
van den Bergh
Jan H A M
JH
van Velthoven
Piet C M
PC
Grijseels
Els W M
EW
D000368:Aged; D002289:Carcinoma, Non-Small-Cell Lung / Q000000981:diagnostic imaging* / Q000601:surgery; D003362:Cost-Benefit Analysis; D005260:Female; D019788:Fluorodeoxyglucose F18; D017721:Hospital Costs / Q000706:statistics & numerical data*; D006801:Humans; D008175:Lung Neoplasms / Q000000981:diagnostic imaging* / Q000601:surgery; D008297:Male; D008875:Middle Aged; D017059:Models, Econometric; D009367:Neoplasm Staging / Q000191:economics*; D009426:Netherlands; D011300:Preoperative Care / Q000191:economics*; D011379:Prognosis; D019275:Radiopharmaceuticals; D012189:Retrospective Studies; D014055:Tomography, Emission-Computed / Q000191:economics*
D019275:Radiopharmaceuticals; D019788:Fluorodeoxyglucose F18