title: Use of a decision analysis model to assess the medicoeconomic implications of FDG PET imaging in diagnosing a solitary pulmonary nodule.
abstract: This study assessed the use of positron emission tomography (PET) in identifying and diagnosing solitary pulmonary nodules (SPNs). For this a decision analysis model was constructed, and three alternatives were compared: wait and watch (WW), PET and anatomical computed tomography (PET), and CT plus PET (CT+PET). Transition probabilities were estimated from published data and consultations with experts. Costs of diagnosis were derived from the French reimbursement scale, and treatment costs from a national hospital database of diagnosis-related groups. The base case was defined as a 65-year-old male smoker with a 2-cm SPN and an associated high risk of malignancy of 43%. Evaluation criteria included incremental cost-effectiveness ratios and the proportion of unnecessary operations avoided in patients without malignant SPN. For the base case WW was the least effective and cheapest strategy. CT+PET was more effective and presented lower incremental cost-effectiveness ratio (<euro>3,022 per life-year gained). It also was superior to PET in cost-effectiveness terms and resulted in 4.3% fewer unnecessary resections of benign SPN than did PET. Risk profile analyses performed on SPN malignancy risk showed that CT + PET remains the most cost-effective strategy in the range of 5.7-87%, and that WW is more cost-effective in the range of 0.3-5.0%. CT+PET is thus cost-effective in detecting malignant SPN in patients with a risk of malignity of at least 5.7% and may avoid inappropriate resections of benign SPN. These findings support the attempts to introduce a larger number of PETs in France for SPN diagnosis.
authors.affiliation: Faculté de Médecine, Dijon, France. catherine.lejeune@u-bourgogne.fr
authors.forename: Catherine
authors.initials: C
authors.lastname: Lejeune
authors.forename: Kazem
authors.initials: K
authors.lastname: Al Zahouri
authors.forename: Marie-Christine
authors.initials: MC
authors.lastname: Woronoff-Lemsi
authors.forename: Patrick
authors.initials: P
authors.lastname: Arveux
authors.forename: Alain
authors.initials: A
authors.lastname: Bernard
authors.forename: Christine
authors.initials: C
authors.lastname: Binquet
authors.forename: Francis
authors.initials: F
authors.lastname: Guillemin
mesh_terms: D000368:Aged; D003362:Cost-Benefit Analysis; D003661:Decision Support Techniques; D019788:Fluorodeoxyglucose F18; D005602:France; D017048:Health Care Costs; D006801:Humans; D008017:Life Expectancy; D008175:Lung Neoplasms / Q000175:diagnosis; D008297:Male; D049268:Positron-Emission Tomography / Q000191:economics* / Q000706:statistics & numerical data; D003074:Solitary Pulmonary Nodule / Q000000981:diagnostic imaging*
chemical_list: D019788:Fluorodeoxyglucose F18