title: Consistency of FDG-PET accuracy and cost-effectiveness in initial staging of patients with Hodgkin lymphoma across jurisdictions.
abstract: BACKGROUND
  Two hundred ten patients with newly diagnosed Hodgkin's lymphoma (HL) were consecutively enrolled in this prospective trial to evaluate the cost-effectiveness of fluorine-18 ((18)F)-fluoro-2-deoxy-D-glucose-positron emission tomography (FDG-PET) scan in initial staging of patients with HL.
  
  
  METHODS
  All 210 patients were staged with conventional clinical staging (CCS) methods, including computed tomography (CT), bone marrow biopsy (BMB), and laboratory tests. Patients were also submitted to metabolic staging (MS) with whole-body FDG-PET scan before the beginning of treatment. A standard of reference for staging was determined with all staging procedures, histologic examination, and follow-up examinations. The accuracy of the CCS was compared with the MS. Local unit costs of procedures and tests were evaluated. Incremental cost-effectiveness ratio (ICER) was calculated for both strategies.
  
  
  RESULTS
  In the 210 patients with HL, the sensitivity for initial staging of FDG-PET was higher than that of CT and BMB in initial staging (97.9% vs. 87.3%; P < .001 and 94.2% vs. 71.4%, P < 0.003, respectively). The incorporation of FDG-PET in the staging procedure upstaged disease in 50 (24%) patients and downstaged disease in 17 (8%) patients. Changes in treatment would be seen in 32 (15%) patients. Cumulative cost for staging procedures was $3751/patient for CCS compared to $5081 for CCS + PET and $4588 for PET/CT. The ICER of PET/CT strategy was $16,215 per patient with modified treatment. PET/CT costs at the beginning and end of treatment would increase total costs of HL staging and first-line treatment by only 2%.
  
  
  CONCLUSIONS
  FDG-PET is more accurate than CT and BMB in HL staging. Given observed probabilities, FDG-PET is highly cost-effective in the public health care program in Brazil.
authors.affiliation: Department of Nuclear Medicine, University of São Paulo Medical School, São Paulo, Brazil. cercijuliano@hotmail.com
authors.forename: Juliano J
authors.initials: JJ
authors.lastname: Cerci
authors.forename: Evelinda
authors.initials: E
authors.lastname: Trindade
authors.forename: Valeria
authors.initials: V
authors.lastname: Buccheri
authors.forename: Stefano
authors.initials: S
authors.lastname: Fanti
authors.forename: Artur M N
authors.initials: AM
authors.lastname: Coutinho
authors.forename: Lucia
authors.initials: L
authors.lastname: Zanoni
authors.forename: Camila C G
authors.initials: CC
authors.lastname: Linardi
authors.forename: Monica
authors.initials: M
authors.lastname: Celli
authors.forename: Dominique
authors.initials: D
authors.lastname: Delbeke
authors.forename: Luís F
authors.initials: LF
authors.lastname: Pracchia
authors.forename: Felipe A
authors.initials: FA
authors.lastname: Pitela
authors.forename: José
authors.initials: J
authors.lastname: Soares
authors.forename: Pier Luigi
authors.initials: PL
authors.lastname: Zinzani
authors.forename: José C
authors.initials: JC
authors.lastname: Meneghetti
mesh_terms: D000293:Adolescent; D001706:Biopsy / Q000379:methods; D001853:Bone Marrow / Q000473:pathology*; D001938:Brazil; D003362:Cost-Benefit Analysis; D005260:Female; D019788:Fluorodeoxyglucose F18; D006689:Hodgkin Disease / Q000175:diagnosis* / Q000000981:diagnostic imaging / Q000473:pathology; D006801:Humans; D008297:Male; D008875:Middle Aged; D009367:Neoplasm Staging / Q000191:economics; D049268:Positron-Emission Tomography / Q000191:economics*; D011446:Prospective Studies; D019275:Radiopharmaceuticals; D014057:Tomography, X-Ray Computed / Q000191:economics*
chemical_list: D019275:Radiopharmaceuticals; D019788:Fluorodeoxyglucose F18