Analysis models to assess cost effectiveness of the four strategies for the work-up of solitary pulmonary nodules.
BACKGROUND
To evaluate the role of computed tomography (CT) -guided needle biopsy and sodium iodide fluorine-18 fluorodeoxyglucose positron emission tomography (FDG-PET) in the investigation of solitary pulmonary nodules (SPN), which are discovered on screening chest radiographs, and to determine the cost-effectiveness of these modalities.


METHODS
We have used decision-tree analysis models to assess the accuracy and cost-effectiveness of four strategies for the diagnosis and management of SPNs: CT alone strategy (baseline), CT plus FDG-PET strategy, CT plus FDG-PET plus CT-guided needle biopsy strategy, and CT plus CT-guided needle biopsy strategy. Reported values of prevalence of cancer, and sensitivity and specificity of each diagnostic modality were applied to the decision-tree models using Japanese health care costs.


RESULTS
The prevalence of lung cancer among SPNs discovered on the lung cancer screening was less than 10%. In this prevalence, the strategies using CT-guided needle biopsy were the cost-effective alternatives to the CT alone strategy (cost saving was 436,470 yen - 456,478 yen per patient), and had higher accuracies (95-96% vs. 67%). Both effects were mainly the result of reducing the number of the candidates who undergo unnecessary thoracotomy for a benign SPN, and these results were true over a wide range of prevalence of cancer (0-55%). The cost saving and accuracy of the CT plus FDG-PET strategy (359,206 and 92%) were approaching to those of the strategies using CT-guided needle biopsy.


CONCLUSIONS
The introduction of CT-guided needle biopsy and FDG-PET for the evaluation of SPNs, which are discovered on screening chest radiograph, is potentially cost-effective in Japan with high accuracy.
Tsushima
Yoshito
Y
Department of Radiology, Motojima General Hospital, Ohta, Gunma, Japan. yoshito@xa2.so-net.ne.jp
Endo
Keigo
K
D003362:Cost-Benefit Analysis; D003663:Decision Trees; D019788:Fluorodeoxyglucose F18 / Q000494:pharmacology; D006801:Humans; D008175:Lung Neoplasms / Q000175:diagnosis*; D008403:Mass Screening; D015995:Prevalence; D019275:Radiopharmaceuticals; D012680:Sensitivity and Specificity; D003074:Solitary Pulmonary Nodule / Q000000981:diagnostic imaging*; D014055:Tomography, Emission-Computed; D014057:Tomography, X-Ray Computed / Q000191:economics*
D019275:Radiopharmaceuticals; D019788:Fluorodeoxyglucose F18