title: Economic analyses on the use of positron emission tomography for the work-up of solitary pulmonary nodules and for staging patients with non-small-cell-lung-cancer in Italy.
abstract: OBJECTIVE
  Increasing ageing of the population and tumor incidence, along with worldwide rationing of the resources for public health systems, spur the use of economic analyses for the choice of strategies and technologies in the assessment and management of cancer patients. Incidence and clinical managing of tumors vary in different countries even if positron emission tomography (PET) with 2-deoxy-2-[18F]-fluoro-D-glucose (FDG) is becoming a routine clinical method for diagnosis, staging, treatment monitoring and follow-up in a variety of tumors. Available data indicate that PET can be considered a superior alternative or complementary tool to other well-established methods. However, in spite of the above and of the rapidly increasing number of PET centers in Europe, USA and Japan, only a few studies have dealt with some of the economic aspects raised by the clinical use of PET because of differences in values of reimbursements and health costs. The main aim of this study is to propose and discuss an economic model of analysis for PET applications in the field of detection and management of pulmonary tumors.
  
  
  METHODS
  In this study 2 assessments were performed by decision tree analysis on the economic impact of the availability of PET on decision-making processes for 2 conditions: solitary pulmonary nodules assessment and non-small-cell lung cancer (NSCLC) staging. In order to define a methodology consistent with the system of reimbursement and the prevalent clinical views of the Italian National Health Service, data on costs, death probability, and life expectancy were gathered from the literature and from the Italian system of reimbursement (ROD-DRGs).
  
  
  RESULTS
  The results of the cost minimization analysis demonstrate that the use of PET in the diagnostic path for the workup of patients with SPN reduces the overall diagnostic costs, by approximately 50 Euro per patient, by reducing inappropriate invasive diagnostic investigation and their complications. The results of the cost effectiveness analysis demonstrate that the use of PET in the diagnostic path for the staging of patients with NSCLC reduces the overall diagnostic costs by approximately 108 Euro for added year, by reducing inappropriate surgical interventions and their complications.
  
  
  CONCLUSIONS
  Both analyses are based on standard methods used in the literature, so our conclusions can be compared with results and assessments of similar studies in different countries and health care systems. Also in the Italian case, the use of an economic assessment provides relevant information on the efficacy and effectiveness of PET.
authors.affiliation: Cergas, Bocconi University, Milan, Italy.
authors.forename: A
authors.initials: A
authors.lastname: Gugiatti
authors.forename: A
authors.initials: A
authors.lastname: Grimaldi
authors.forename: C
authors.initials: C
authors.lastname: Rossetti
authors.forename: G
authors.initials: G
authors.lastname: Lucignani
authors.forename: D
authors.initials: D
authors.lastname: De Marchis
authors.forename: E
authors.initials: E
authors.lastname: Borgonovi
authors.forename: F
authors.initials: F
authors.lastname: Fazio
mesh_terms: D002289:Carcinoma, Non-Small-Cell Lung / Q000000981:diagnostic imaging* / Q000191:economics; D017046:Cost Savings; D003362:Cost-Benefit Analysis; D006801:Humans; D007558:Italy; D008175:Lung Neoplasms / Q000000981:diagnostic imaging* / Q000191:economics; D012680:Sensitivity and Specificity; D003074:Solitary Pulmonary Nodule / Q000000981:diagnostic imaging* / Q000191:economics; D014055:Tomography, Emission-Computed / Q000191:economics*