title: Positron emission tomography with selected mediastinoscopy compared to routine mediastinoscopy offers cost and clinical outcome benefits for pre-operative staging of non-small cell lung cancer.
abstract: OBJECTIVE
  (18)F-fluorodeoxyglucose positron emission tomography (FDG-PET) imaging is an important staging procedure in patients with non-small cell lung cancer (NSCLC). We aimed to demonstrate, through a decision tree model and the incorporation of real costs of each component, that routine FDG-PET imaging as a prelude to curative surgery will reduce requirements for routine mediastinoscopy and overall hospital costs.
  
  
  METHODS
  A decision tree model comparing routine whole-body FDG-PET imaging to routine staging mediastinoscopy was used, with baseline variables of sensitivity, specificity and prevalence of non-operable and metastatic disease obtained from institutional data and a literature review. Costings for hospital admissions for mediastinoscopy and thoracotomy of actual patients with NSCLC were determined. The overall and average cost of managing patients was then calculated over a range of FDG-PET costs to derive projected cost savings to the community.
  
  
  RESULTS
  The prevalence of histologically proven mediastinal involvement in patients with NSCLC presenting for surgical assessment at our institution is 20%, and the prevalence of distant metastatic disease is 6%. Based on literature review, the pooled sensitivity and specificity of FDG-PET for detection of mediastinal spread are 84% and 89% respectively, and for mediastinoscopy, 81% and 100%. The average cost of mediastinoscopy for NSCLC in our institution is 4,160 AUD, while that of thoracotomy is 15,642 AUD. The cost of an FDG-PET scan is estimated to be 1,500 AUD. Using these figures and the decision tree model, the average cost saving is 2,128 AUDper patient.
  
  
  CONCLUSIONS
  Routine FDG-PET scanning with selective mediastinoscopy will save 2,128 AUD per patient and will potentially reduce inappropriate surgery. These cost savings remain robust over a wide range of disease prevalence and FDG-PET costs.
authors.affiliation: Centre for PET, University of Melbourne, Austin Hospital Heidelberg, Victoria, 3084, Australia.
authors.forename: Kelvin K
authors.initials: KK
authors.lastname: Yap
authors.forename: Kenneth S K
authors.initials: KS
authors.lastname: Yap
authors.forename: Amanda J
authors.initials: AJ
authors.lastname: Byrne
authors.forename: Salvatore U
authors.initials: SU
authors.lastname: Berlangieri
authors.forename: Aurora
authors.initials: A
authors.lastname: Poon
authors.forename: Paul
authors.initials: P
authors.lastname: Mitchell
authors.forename: Simon R
authors.initials: SR
authors.lastname: Knight
authors.forename: Peter C
authors.initials: PC
authors.lastname: Clarke
authors.forename: Anthony
authors.initials: A
authors.lastname: Harris
authors.forename: Andrew
authors.initials: A
authors.lastname: Tauro
authors.forename: Christopher C
authors.initials: CC
authors.lastname: Rowe
authors.forename: Andrew M
authors.initials: AM
authors.lastname: Scott
mesh_terms: D000328:Adult; D000368:Aged; D000369:Aged, 80 and over; D001315:Australia; D002289:Carcinoma, Non-Small-Cell Lung / Q000000981:diagnostic imaging* / Q000191:economics* / Q000473:pathology / Q000601:surgery; D003362:Cost-Benefit Analysis; D020000:Decision Support Systems, Clinical; D005260:Female; D017048:Health Care Costs / Q000706:statistics & numerical data; D006801:Humans; D007902:Length of Stay / Q000191:economics; D008175:Lung Neoplasms / Q000000981:diagnostic imaging* / Q000191:economics* / Q000473:pathology / Q000601:surgery; D008297:Male; D008481:Mediastinoscopy / Q000191:economics*; D008875:Middle Aged; D018803:Models, Economic; D009367:Neoplasm Staging / Q000191:economics; D049268:Positron-Emission Tomography / Q000191:economics*; D012189:Retrospective Studies; D016896:Treatment Outcome