18FDG-PET-CT in the follow-up of non-small cell lung cancer patients after radical radiotherapy with or without chemotherapy: an economic evaluation.
BACKGROUND
The optimal follow-up strategy of non-small cell lung cancer (NSCLC) patients after curative intent therapy is still not established. In a recent prospective study with 100 patients, we showed that a FDG-PET-CT 3 months after radiotherapy (RT) could identify progression amenable for curative treatment in 2% (95% confidence interval (CI): 1-7%) of patients, who were all asymptomatic. Here, we report on the economic evaluation of this study.


METHODS
A decision-analytic Markov model was developed in which the long-term cost-effectiveness of 3 follow-up strategies was modelled with different imaging methods 3 months after therapy: a PET-CT scan; a chest CT scan; and conventional follow-up with a chest X-ray. A probabilistic sensitivity analysis was performed to account for uncertainty. Because the results of the prospective study indicated that the advantage seems to be confined to asymptomatic patients, we additionally examined a strategy where a PET-CT was applied only in the subgroup of asymptomatic patients. Cost-effectiveness of the different follow-up strategies was expressed in incremental cost-effectiveness ratios (ICERs), calculating the incremental costs per quality adjusted life year (QALY) gained.


RESULTS
Both PET-CT- and CT-based follow-up were more costly but also more effective than conventional follow-up. CT-based follow-up was only slightly more effective than conventional follow-up, resulting in an incremental cost-effectiveness ratio (ICER) of euro 264.033 per QALY gained. For PET-CT-based follow-up, the ICER was euro 69.086 per QALY gained compared to conventional follow-up. The strategy in which a PET-CT was only performed in the asymptomatic subgroup resulted in an ICER of euro 42.265 per QALY gained as opposed to conventional follow-up. With this strategy, given a ceiling ratio of euro 80.000, PET-CT-based follow-up had the highest probability of being cost-effective (73%).


CONCLUSIONS
This economic evaluation shows that a PET-CT scan 3 months after (chemo)radiotherapy with curative intent is a potentially cost-effective follow-up method, and is more cost-effective than CT alone. Applying a PET-CT scan only in asymptomatic patients is probably as effective and more cost-effective. It is worthwhile to perform additional research to reduce uncertainty regarding the decision concerning imaging in the follow-up of NSCLC.
van Loon
Judith
J
Department of Radiation Oncology (Maastro Clinic), GROW Research Institute, Maastricht University Medical Centre(+), Maastricht, The Netherlands. Judith.vanloon@maastro.nl
Grutters
Janneke P C
JP
Wanders
Rinus
R
Boersma
Liesbeth
L
Dingemans
Anne-Marie C
AM
Bootsma
Gerben
G
Geraedts
Wiel
W
Pitz
Cordula
C
Simons
Jean
J
Brans
Boudewijn
B
Snoep
Gabriel
G
Hochstenbag
Monique
M
Lambin
Philippe
P
De Ruysscher
Dirk
D
D000328:Adult; D000368:Aged; D000369:Aged, 80 and over; D000971:Antineoplastic Combined Chemotherapy Protocols / Q000627:therapeutic use; D002289:Carcinoma, Non-Small-Cell Lung / Q000000981:diagnostic imaging* / Q000191:economics / Q000628:therapy; D003362:Cost-Benefit Analysis; D004812:Epidemiologic Methods; D005260:Female; D019788:Fluorodeoxyglucose F18; D017048:Health Care Costs / Q000706:statistics & numerical data; D006801:Humans; D008134:Long-Term Care / Q000191:economics / Q000379:methods; D008175:Lung Neoplasms / Q000000981:diagnostic imaging* / Q000191:economics / Q000628:therapy; D008297:Male; D008875:Middle Aged; D049268:Positron-Emission Tomography / Q000191:economics; D011788:Quality of Life; D019275:Radiopharmaceuticals; D014057:Tomography, X-Ray Computed / Q000191:economics
D019275:Radiopharmaceuticals; D019788:Fluorodeoxyglucose F18