Cost-effectiveness of hybrid PET/CT for staging of non-small cell lung cancer.
Although the diagnostic effectiveness of integrated PET/CT for staging of non-small cell lung cancer (NSCLC) has already been proven, it remains to be determined if tumor staging with combined metabolic and anatomic imaging is also cost-effective. The objective of this study was to evaluate from a payers' perspective the cost-effectiveness of staging NSCLC with CT alone (representing the mainstay diagnostic test) and with integrated PET/CT.


METHODS
The study is based on 172 NSCLC patients from a prospective clinical study who underwent diagnostic, contrast-enhanced helical CT and integrated PET/CT. Imaging was performed at the University Hospital Ulm between May 2002 and December 2004. To calculate treatment costs, we differentiated among cost for diagnosis, cost for nonsurgical treatment according to the clinical diagnosis, and cost for surgical procedures according to the clinical tumor stage.


RESULTS
The diagnostic effectiveness in terms of correct TNM staging was 40% (31/77) for CT alone and 60% (46/77) for PET/CT. For the assessment of resectability (tumor stages Ia-IIIa vs. IIIb-IV), 65 of 77 patients (84%) were staged correctly by PET/CT (CT alone, 70% [54/77]). The incremental cost-effectiveness ratios per correctly staged patient were $3,508 for PET/CT versus CT alone. The incremental cost-effectiveness ratios per quality-adjusted life year gained were $79,878 for PET/CT vs. CT alone, decreasing to $69,563 assuming a reduced loss of utility (0.10 quality-adjusted life years) due to surgical morbidity.


CONCLUSIONS
Cost-effectiveness analyses showed that costs for PET/CT are within the commonly accepted range for diagnostic tests or therapies. Therefore, reimbursement of PET/CT for NSCLC staging can be also recommended from an economic point of view.
Institute of Health Economics and Health Care Management, Helmholtz Zentrum München, German Research Center for Environmental Health, Neuherberg, Germany. schreyoegg@bwl.lmu.de
Jonas
J
Schreyögg
Julia
J
Weller
Tom
T
Stargardt
Ken
K
Herrmann
Christina
C
Bluemel
Tobias
T
Dechow
Gerhard
G
Glatting
Bernd J
BJ
Krause
Felix
F
Mottaghy
Sven N
SN
Reske
Andreas K
AK
Buck
D000368:Aged; D002289:Carcinoma, Non-Small-Cell Lung / Q000000981:diagnostic imaging / Q000191:economics* / Q000473:pathology*; D003362:Cost-Benefit Analysis; D003657:Decision Making; D005260:Female; D006801:Humans; D007349:Insurance, Health, Reimbursement / Q000191:economics; D008175:Lung Neoplasms / Q000000981:diagnostic imaging / Q000191:economics* / Q000473:pathology*; D008297:Male; D008875:Middle Aged; D009367:Neoplasm Staging / Q000191:economics*; D049268:Positron-Emission Tomography / Q000191:economics*; D016016:Proportional Hazards Models; D019057:Quality-Adjusted Life Years; D012680:Sensitivity and Specificity; D014057:Tomography, X-Ray Computed / Q000191:economics*