Cost-effectiveness of FDG-PET in staging non-small cell lung cancer: the PLUS study.
Currently, up to 50% of the operations in early-stage non-small cell lung cancer (NSCLC) are futile owing to the presence of locally advanced tumour or distant metastases. More accurate pre-operative staging is required in order to reduce the number of futile operations. The cost-effectiveness of fluorine-18 fluorodeoxyglucose positron emission tomography ((18)FDG-PET) added to the conventional diagnostic work-up was studied in the PLUS study. Prior to invasive staging and/or thoracotomy, 188 patients with (suspected) NSCLC were randomly assigned to conventional work-up (CWU) and whole-body PET or to CWU alone. CWU was based on prevailing guidelines. Pre-operative staging was followed by 1 year of follow-up. Outcomes are expressed in the percentage of correctly staged patients and the associated costs. The cost price of PET varied between <euro>736 and <euro>1,588 depending on the (hospital) setting and the procurement of (18)FDG commercially or from on-site production. In the CWU group, 41% of the patients underwent a futile thoracotomy, whereas in the PET group 21% of the thoracotomies were considered futile ( P=0.003). The average costs per patient in the CWU group were <euro>9,573 and in the PET group, <euro>8,284. The major cost driver was the number of hospital days related to recovery from surgery. Sensitivity analysis on the cost and accuracy of PET showed that the results were robust, i.e. in favour of the PET group. The addition of PET to CWU prevented futile surgery in one out of five patients with suspected NSCLC. Despite the additional PET costs, the total costs were lower in the PET group, mainly due to a reduction in the number of futile operations. The additional use of PET in the staging of patients with NSCLC is feasible, safe and cost saving from a clinical and from an economic perspective.
Institute for Medical Technology Assessment, Erasmus Medical Centre/Erasmus University Rotterdam, P.O. Box 1738, 3000 DR, Rotterdam, The Netherlands.
Paul
P
Verboom
Harm
H
van Tinteren
Otto S
OS
Hoekstra
Egbert F
EF
Smit
Jan H A M
JH
van den Bergh
Ad J M
AJ
Schreurs
Roland A L M
RA
Stallaert
Piet C M
PC
van Velthoven
Emile F I
EF
Comans
Fred W
FW
Diepenhorst
Johan C
JC
van Mourik
Pieter E
PE
Postmus
Maarten
M
Boers
Els W M
EW
Grijseels
Gerrit J J
GJ
Teule
Carin A
CA
Uyl-de Groot
D000368:Aged; D002289:Carcinoma, Non-Small-Cell Lung / Q000175:diagnosis / Q000000981:diagnostic imaging* / Q000191:economics*; D003362:Cost-Benefit Analysis / Q000379:methods*; D005260:Female; D019788:Fluorodeoxyglucose F18 / Q000191:economics*; D017048:Health Care Costs / Q000706:statistics & numerical data; D006801:Humans; D008175:Lung Neoplasms / Q000175:diagnosis / Q000000981:diagnostic imaging* / Q000191:economics*; D008297:Male; D009367:Neoplasm Staging / Q000191:economics / Q000379:methods; D009426:Netherlands; D019275:Radiopharmaceuticals / Q000191:economics; D015203:Reproducibility of Results; D018570:Risk Assessment / Q000191:economics / Q000379:methods; D012680:Sensitivity and Specificity; D014055:Tomography, Emission-Computed / Q000191:economics* / Q000379:methods
D019275:Radiopharmaceuticals; D019788:Fluorodeoxyglucose F18