Cost-effectiveness analysis of FDG PET-CT in the management of pulmonary metastases from malignant melanoma.
OBJECTIVE
Most guidelines consider FDG PET-CT to detect occult extra-pulmonary disease prior to lung metastasectomy. A cost-effectiveness analysis, using a Markov model over a 10 year period, was performed to compare two different surveillance programs, either PET-CT or whole-body CT, in patients with suspected pulmonary metastasised melanoma.


METHODS
Data from published studies provided probabilities for the model. Complication and care costs were obtained from standardised administrative databases from 19 hospitals identified by DRG codes (reported in 2009 Euros). For the cost calculation of PET-CT we performed a microcosting analysis. All costs and benefits were yearly discounted at respectively 3% and 1.5%. Outcomes included life-months gained (LMG) and the number of futile surgeries avoided. Cost-effectiveness ratios were in Euros per LMG. Univariate and probabilistic sensitivity analyses addressed uncertainty in all model parameters.


RESULTS
The PET-CT strategy provided 86.29 LMG (95% CI: 81.50-90.88 LMG) at a discounted cost of euro3,974 (95% CI: euro1,339-12,303), while the conventional strategy provided 86.08 LMG (95% CI: 81.37-90.68 LMG) at a discounted cost of euro5,022 (95% CI: euro1,378-16,018). This PET-CT strategy resulted in a net saving of euro1,048 with a gain of 0.2 LMG. Based on PET-CT findings, 20% of futile surgeries could be avoided.


CONCLUSIONS
Integrating PET-CT in the management of patients with high risk MM appears to be less costly and more accurate by avoiding futile thoracotomies in one of five patients as well as by providing a small survival benefit at 10 years.
Krug
Bruno
B
Nuclear Medicine Division, Mont-Godinne University Hospital, Université Catholique de Louvain, Yvoir, Belgium. bruno.krug@uclouvain.be
Crott
Ralph
R
Roch
Isabelle
I
Lonneux
Max
M
Beguin
Claire
C
Baurain
Jean-François
JF
Pirson
Anne-Sophie
AS
Vander Borght
Thierry
T
D003362:Cost-Benefit Analysis; D019788:Fluorodeoxyglucose F18 / Q000191:economics; D006801:Humans; D008175:Lung Neoplasms / Q000175:diagnosis / Q000191:economics* / Q000556:secondary; D008545:Melanoma / Q000175:diagnosis / Q000191:economics* / Q000556:secondary; D049268:Positron-Emission Tomography / Q000191:economics*; D019275:Radiopharmaceuticals / Q000191:economics; D012878:Skin Neoplasms / Q000175:diagnosis / Q000191:economics*; D014057:Tomography, X-Ray Computed / Q000191:economics*
D019275:Radiopharmaceuticals; D019788:Fluorodeoxyglucose F18