Added value of positron emission tomography imaging in the surgical treatment of colorectal liver metastases.
OBJECTIVE
[F-18]-Fluorodeoxyglucose-positron emission tomography (FDG-PET) is used increasingly in the work-up to surgery for patients with potentially resectable colorectal liver metastases. This study evaluates the clinical effectiveness, impact on health care resources and cost-effectiveness of adding FDG-PET to the diagnostic algorithm alongside a randomized clinical trial from a health care perspective.


METHODS
In a randomized clinical trial, the net monetary benefit (NMB) of FDG-PET added to conventional diagnostic work-up (CWU) was determined in patients with colorectal liver metastases. Seventy-five patients were included in each arm. Change in clinical management, futile laparotomies, preoperative findings and all relevant health care consumption were prospectively documented during 3 years. To assess health-related quality of life European Quality of Life-5 Dimensions was administered at the time of randomization, 3 and 6 weeks postoperatively, and every 3 months postoperatively for 3 years. Quality-adjusted life years (QALYs) were calculated based on European Quality of Life-5 Dimensions outcomes.


RESULTS
In adding FDG-PET, diagnostic performance increased and futile laparotomies were reduced by 38%. Both health-related quality of life and QALYs showed no significant difference between the CWU and PET groups. For CWU and PET groups costs were euro 92,836 and euro 81,776, respectively, accumulated in 3 years after randomization. NMB ranged from euro 1004 to euro 11,060 depending on the monetary value given to a QALY. When costs for chemotherapy were disregarded, costs amounted to euro 15,874 for CWU and euro 18,664 for PET group.


CONCLUSIONS
Additional costs of FDG-PET in the diagnostic work-up of patients with potentially resectable colorectal liver metastases were compensated by a reduction in futile laparotomies. The NMB analysis showed savings over a relevant range of willingness to pay for a QALY.
Wiering
Bastiaan
B
Department of Surgery, Division of Surgical Oncology, Radboud University Nijmegen Medical Centre, Nijmegen, The Netherlands. b.wiering@chir.umcn.nl
Adang
Eddy M M
EM
van der Sijp
Joost R M
JR
Roumen
Rudi M
RM
de Jong
Koert P
KP
Comans
Emile F I
EF
Pruim
Jan
J
Dekker
Helena M
HM
Ruers
Theo J M
TJ
Krabbe
Paul F M
PF
Oyen
Wim J G
WJ
D000328:Adult; D000368:Aged; D000369:Aged, 80 and over; D015179:Colorectal Neoplasms / Q000473:pathology*; D003365:Costs and Cost Analysis; D005260:Female; D019788:Fluorodeoxyglucose F18; D006801:Humans; D008113:Liver Neoplasms / Q000000981:diagnostic imaging* / Q000556:secondary / Q000601:surgery* / Q000628:therapy; D008297:Male; D008875:Middle Aged; D049268:Positron-Emission Tomography; D019057:Quality-Adjusted Life Years; D012680:Sensitivity and Specificity; D016896:Treatment Outcome
D019788:Fluorodeoxyglucose F18