title: Chest CT and whole-body 18F-FDG PET are cost-effective in screening for distant metastases in head and neck cancer patients.
abstract: The aim of the study was to define the cost-effectiveness of whole-body (18)F-FDG PET, as compared with chest CT, in screening for distant metastases in patients with head and neck squamous cell carcinoma (HNSCC).
  
  
  METHODS
  In a multicenter prospective study, 145 consecutive patients with high risk factors for distant metastases and scheduled for extensive treatment underwent chest CT and whole-body (18)F-FDG PET for screening of distant metastases. The cost data of 80 patients in whom distant metastases developed or who had a follow-up of at least 12 mo were analyzed. Cost-effectiveness analysis, including sensitivity analysis, was performed to compare the results of (18)F-FDG PET, CT, and a combination of CT and (18)F-FDG PET (CT + (18)F-FDG PET).
  
  
  RESULTS
  Pretreatment screening identified distant metastases in 21% of patients. (18)F-FDG PET had a higher sensitivity (53% vs. 37%) and positive predictive value (80% vs. 75%) than did CT. CT + (18)F-FDG PET had the highest sensitivity (63%). The average costs in the CT, (18)F-FDG PET, and CT + (18)F-FDG PET groups amounted to euro38,558 (approximately $57,705), euro38,355 (approximately $57,402), and euro37,954 (approximately $56,801), respectively, in the first year after screening. CT + (18)F-FDG PET resulted in savings between euro203 (approximately $303) and euro604 (approximately $903). Sensitivity analysis showed that the dominance of CT + (18)F-FDG PET was robust.
  
  
  CONCLUSIONS
  In HNSCC patients with risk factors, pretreatment screening for distant metastases by chest CT is improved by (18)F-FDG PET. The combination of (18)F-FDG PET with CT is the most effective, without leading to additional costs.
authors.affiliation: Institute for Medical Technology Assessment, Erasmus MC, University Medical Center Rotterdam, Rotterdam, The Netherlands. uyl@bmg.eur.nl
authors.forename: Carin A
authors.initials: CA
authors.lastname: Uyl-de Groot
authors.forename: Asaf
authors.initials: A
authors.lastname: Senft
authors.forename: Remco
authors.initials: R
authors.lastname: de Bree
authors.forename: C René
authors.initials: CR
authors.lastname: Leemans
authors.forename: Otto S
authors.initials: OS
authors.lastname: Hoekstra
mesh_terms: D000328:Adult; D000368:Aged; D000369:Aged, 80 and over; D002294:Carcinoma, Squamous Cell / Q000000981:diagnostic imaging* / Q000191:economics / Q000556:secondary / Q000628:therapy; D003362:Cost-Benefit Analysis; D003365:Costs and Cost Analysis; D003951:Diagnostic Errors; D005260:Female; D005462:Fluorine Radioisotopes; D019788:Fluorodeoxyglucose F18; D006258:Head and Neck Neoplasms / Q000000981:diagnostic imaging* / Q000191:economics / Q000628:therapy; D006801:Humans; D008297:Male; D008875:Middle Aged; D049268:Positron-Emission Tomography / Q000191:economics*; D011446:Prospective Studies; D019275:Radiopharmaceuticals; D014057:Tomography, X-Ray Computed / Q000191:economics*
chemical_list: D005462:Fluorine Radioisotopes; D019275:Radiopharmaceuticals; D019788:Fluorodeoxyglucose F18