title: Preoperative staging of lung cancer with PET/CT: cost-effectiveness evaluation alongside a randomized controlled trial.
abstract: OBJECTIVE
  Positron emission tomography (PET)/CT has become a widely used technology for preoperative staging of non-small cell lung cancer (NSCLC). Two recent randomized controlled trials (RCT) have established its efficacy over conventional staging, but no studies have assessed its cost-effectiveness. The objective of this study was to assess the cost-effectiveness of PET/CT as an adjunct to conventional workup for preoperative staging of NSCLC.
  
  
  METHODS
  The study was conducted alongside an RCT in which 189 patients were allocated to conventional staging (n = 91) or conventional staging + PET/CT (n = 98) and followed for 1 year after which the numbers of futile thoracotomies in each group were monitored. A full health care sector perspective was adapted for costing resource use. The outcome parameter was defined as the number needed to treat (NNT)-here number of PET/CT scans needed-to avoid one futile thoracotomy. All monetary estimates were inflated to 2010 <euro>.
  
  
  RESULTS
  The incremental cost of the PET/CT-based regimen was estimated at 3,927 <euro> [95% confidence interval (CI) -3,331; 10,586] and the NNT at 4.92 (95% CI 3.00; 13.62). These resulted in an average incremental cost-effectiveness ratio of 19,314 <euro>, which would be cost-effective at a probability of 0.90 given a willingness to pay of 50,000 <euro> per avoided futile thoracotomy. When costs of comorbidity-related hospital services were excluded, the PET/CT regimen appeared dominant.
  
  
  CONCLUSIONS
  Applying a full health care sector perspective, the cost-effectiveness of PET/CT for staging NSCLC seems to depend on the willingness to pay in order to avoid a futile thoracotomy. However, given that four outliers in terms of extreme comorbidity were all randomized to the PET/CT arm, there is uncertainty about the conclusion. When hospital costs of comorbidity were excluded, the PET/CT regimen was found to be both more accurate and cost saving.
authors.affiliation: Centre for Health Service Research and Technology Assessment, University of Southern Denmark, Copenhagen, Denmark. ris@cast.sdu.dk
authors.forename: Rikke
authors.initials: R
authors.lastname: Søgaard
authors.forename: Barbara Malene B
authors.initials: BM
authors.lastname: Fischer
authors.forename: Jann
authors.initials: J
authors.lastname: Mortensen
authors.forename: Liselotte
authors.initials: L
authors.lastname: Højgaard
authors.forename: Ulrik
authors.initials: U
authors.lastname: Lassen
mesh_terms: D000293:Adolescent; D000328:Adult; D000368:Aged; D000369:Aged, 80 and over; D003362:Cost-Benefit Analysis; D005260:Female; D006801:Humans; D008175:Lung Neoplasms / Q000175:diagnosis* / Q000473:pathology* / Q000601:surgery; D008297:Male; D008875:Middle Aged; D009367:Neoplasm Staging / Q000191:economics*; D049268:Positron-Emission Tomography / Q000191:economics*; D057234:Preoperative Period; D012680:Sensitivity and Specificity; D014057:Tomography, X-Ray Computed / Q000191:economics*; D055815:Young Adult