Solitary pulmonary nodules: impact of quantitative contrast-enhanced CT on the cost-effectiveness of FDG-PET.
OBJECTIVE
To determine the impact of quantitative contrast-enhanced computed tomography (QECT) on the cost-effectiveness of diagnostic strategies for the assessment of solitary pulmonary nodules (SPNs).


METHODS
Four diagnostic strategies were evaluated using decision tree analysis: conventional CT alone; conventional CT followed by QECT; conventional CT followed positron emission tomography (PET); and conventional CT followed by QECT and PET (QECT+PET). The average cost per patient, accuracy of management and incremental cost:accuracy ratio (ICAR) were determined for each strategy. Although baseline assumptions reflected the Australian setting, sensitivity analysis was used to extrapolate the results to the UK.


RESULTS
At the baseline prevalence of malignancy (54%) and cost of PET relative to surgery (16%), the QECT strategy incurs the least cost (5560 dollars/patient) but the QECT+PET strategy is the most cost-effective (ICAR 12,059 dollars/patient). At reported levels of disease prevalence (68.5%) and cost of PET relative to surgery (29.9%) in the UK, the QECT strategy is the most cost-effective.


CONCLUSIONS
QECT offers a cost-effective approach to evaluation of SPNs. Whether QECT is used alone or in combination with PET will depend upon local availability and regional values for prior probability of malignancy within SPNs and the cost of PET relative to surgery.
Comber
L A
LA
Southern X-ray Clinics, The Wesley Hospital, Auchenflower, Queensland, Australia.
Keith
C J
CJ
Griffiths
M
M
Miles
K A
KA
D003362:Cost-Benefit Analysis; D003663:Decision Trees; D019788:Fluorodeoxyglucose F18; D006801:Humans; D011856:Radiographic Image Enhancement; D019275:Radiopharmaceuticals; D012680:Sensitivity and Specificity; D003074:Solitary Pulmonary Nodule / Q000175:diagnosis* / Q000191:economics; D014055:Tomography, Emission-Computed / Q000191:economics*; D014057:Tomography, X-Ray Computed / Q000379:methods*; D006113:United Kingdom
D019275:Radiopharmaceuticals; D019788:Fluorodeoxyglucose F18