The cost-utility analysis of 18-fluoro-2-deoxyglucose positron emission tomography in the diagnosis of recurrent nasopharyngeal carcinoma.
OBJECTIVE
18-Fluoro-2-deoxyglucose (18F-FDG) positron emission tomography (PET) is effective but costly in the early detection of recurrence for nasopharyngeal carcinoma (NPC) in patients after treatment. In this study, we developed a decision tree model to analyze the cost utility of 18F-FDG PET in detecting loco-regional recurrences for NPC patients after therapy.


METHODS
The analysis for cost utility is based on the decision-tree model for three different strategies: 1) magnetic resonance imaging (MRI)-only, 2) PET-only, and 3) MRI-PET (performing PET if MRI result is uncertain). Sensitivity analyses have been performed to examine changes in the cost ratio of PET/MRI and the probability of uncertain MRI.


RESULTS
After inputting the data for utilities and life expectancies into the decision tree model, the quality-adjusted life expectancies turn out to be 16.16 quality-adjusted life-years (QALYs) for strategy 1, 16.70 QALYs for strategy 2, and 17.35 QALYs for strategy 3. The additional cost per additional QALYs for strategy 3 relative to strategy 1 is calculated to be US $462. Strategy 3 dominates over strategy 2 because strategy 3 costs less and yields more QALYs than strategy 2. If the cost ratio of PET/MRI is less than 1.85 or the probability of uncertain MRI is greater than 73%, then the PET-only strategy becomes more cost-effective than the MRI-PET strategy.


CONCLUSIONS
Our analysis shows that the MRI-PET strategy is the most cost-effective for now. It is likely the PET-only strategy will become the most cost-effective for recurrent NPC in patients in the near future as the cost of PET has decreased in a faster rate than the cost of MRI.
Yen
Ruoh-Fang
RF
Department of Nuclear Medicine, National Taiwan University Hospital and National Taiwan University College of Medicine, Taipei, Taiwan.
Yen
Ming-Fang
MF
Hong
Ruey-Long
RL
Tzen
Kai-Yuan
KY
Chien
Chun-Ru
CR
Chen
Tony Hsiu-Hsi
TH
D000328:Adult; D003362:Cost-Benefit Analysis; D005260:Female; D019788:Fluorodeoxyglucose F18 / Q000191:economics*; D017048:Health Care Costs / Q000706:statistics & numerical data*; D006801:Humans; D008297:Male; D008875:Middle Aged; D009303:Nasopharyngeal Neoplasms / Q000000981:diagnostic imaging* / Q000191:economics* / Q000401:mortality; D009364:Neoplasm Recurrence, Local / Q000000981:diagnostic imaging* / Q000191:economics* / Q000401:mortality; D049268:Positron-Emission Tomography / Q000191:economics* / Q000706:statistics & numerical data; D019275:Radiopharmaceuticals / Q000191:economics; D013624:Taiwan / Q000453:epidemiology
D019275:Radiopharmaceuticals; D019788:Fluorodeoxyglucose F18