Assessing short-term effects and costs at an early stage of innovation: the use of positron emission tomography on radiotherapy treatment decision making.
OBJECTIVE
Positron emission tomography (PET) is an innovative imaging tool. Associated with computed tomography (CT), it allows a better definition for the tumor volume for radiotherapy, compared with CT only. The aim of this study was to assess the effects of PET on resource allocation (costs and savings) and on the choice of the following treatment in radiotherapy.


METHODS
In 2004 and 2005, 209 patients were enrolled (97 patients with Hodgkin's disease and 112 with non-small cell lung cancer) in a national study conducted in eight hospitals. Two treatment decisions made on the basis of CT only or CT associated with PET, were compared in a prospective study where each subject was his/her own control. The direct medical cost of using PET was assessed by microcosting, using data collected from specific questionnaires. The costs of new tests and the costs and savings associated with changes in the chosen treatment were calculated on the basis of reimbursement rates.


RESULTS
The mean cost of using PET was approximately euro 800 per patient (50 percent for the radionuclide 18F-FDG [2-[18F]fluoro-2-deoxy-D-glucose]). Radiotherapy treatments were modified for 10 percent of patients with Hodgkin's disease versus 40 percent of patients with lung cancer. Overall, the use of PET induced both increases and decreases in the mean cost per patient: the net effect was a euro 425 and euro 931 cost increase in lung cancer and Hodgkin's disease, respectively.


CONCLUSIONS
The use of PET for radiotherapy decision making seems more valuable for lung cancer than for Hodgkin's disease, both in terms of costs and changes in radiotherapy treatment. This result might help policy makers for prioritization.
Remonnay
Raphaël
R
GATE CNRS-UMR 5824, Lyon, France. remonnay@lyon.fnclcc.fr
Morelle
Magali
M
Pommier
Pascal
P
Giammarile
Francesco
F
Carrère
Marie-Odile
MO
D002289:Carcinoma, Non-Small-Cell Lung / Q000191:economics* / Q000532:radiotherapy*; D003365:Costs and Cost Analysis; D003657:Decision Making; D005260:Female; D019788:Fluorodeoxyglucose F18 / Q000191:economics; D006689:Hodgkin Disease / Q000191:economics* / Q000532:radiotherapy*; D006801:Humans; D008175:Lung Neoplasms / Q000191:economics* / Q000532:radiotherapy*; D008297:Male; D049268:Positron-Emission Tomography; D019275:Radiopharmaceuticals / Q000191:economics; D014057:Tomography, X-Ray Computed
D019275:Radiopharmaceuticals; D019788:Fluorodeoxyglucose F18