Cost effectiveness of positron emission tomography in patients with Hodgkin's lymphoma in unconfirmed complete remission or partial remission after first-line therapy.
OBJECTIVE
To assess the cost effectiveness of fluorine-18-fluorodeoxyglucose positron emission tomography (FDG-PET) in patients with Hodgkin's lymphoma (HL) with unconfirmed complete remission (CRu) or partial remission (PR) after first-line treatment.


METHODS
One hundred thirty patients with HL were prospectively studied. After treatment, all patients with CRu/PR were evaluated with FDG-PET. In addition, PET-negative patients were evaluated with standard follow-up, and PET-positive patients were evaluated with biopsies of the positive lesions. Local unit costs of procedures and tests were evaluated. Cost effectiveness was determined by evaluating projected annual economic impact of strategies without and with FDG-PET on HL management.


RESULTS
After treatment, CRu/PR was observed in 50 (40.0%) of the 127 patients; the sensitivity, specificity, and positive and negative predictive values of FDG-PET were 100%, 92.0%, 92.3%, and 100%, respectively (accuracy of 95.9%). Local restaging costs without PET were $350,050 compared with $283,262 with PET, a 19% decrease. The incremental cost-effectiveness ratio is -$3,268 to detect one true case. PET costs represented 1% of total costs of HL treatment. Simulated costs in the 974 patients registered in the 2008 Brazilian public health care database showed that the strategy including restaging PET would have a total program cost of $56,498,314, which is $516,942 less than without restaging PET, resulting in a 1% cost saving.


CONCLUSIONS
FDG-PET demonstrated 95.9% accuracy in restaging for patients with HL with CRu/PR after first-line therapy. Given the observed probabilities, FDG-PET is highly cost effective and would reduce costs for the public health care program in Brazil.
Cerci
Juliano J
JJ
Department of Nuclear Medicine and Health Technology Assessment/Executive Direction, Heart Institute (InCor), University of SãoPaulo Medical School, São Paulo, Brazil. cercijuliano@hotmail.com
Trindade
Evelinda
E
Pracchia
Luís F
LF
Pitella
Felipe A
FA
Linardi
Camila C G
CC
Soares
José
J
Delbeke
Dominique
D
Topfer
Leigh-Ann
LA
Buccheri
Valeria
V
Meneghetti
José C
JC
D000328:Adult; D001938:Brazil; D003131:Combined Modality Therapy; D003362:Cost-Benefit Analysis; D003663:Decision Trees; D005260:Female; D017048:Health Care Costs; D006689:Hodgkin Disease / Q000000981:diagnostic imaging* / Q000191:economics / Q000628:therapy; D006801:Humans; D008297:Male; D009367:Neoplasm Staging; D049268:Positron-Emission Tomography / Q000191:economics*; D011446:Prospective Studies; D016019:Survival Analysis