title: Cost-effectiveness of adding FDG-PET or CT to the diagnostic work-up of patients with stage III melanoma.
abstract: OBJECTIVE
  The aim of this prospective study was to assess predictive value of fludeoxyglucose-positron emission tomography (FDG-PET) and computed tomography (CT) and to analyze their cost-effectiveness in several diagnosis-treatment combinations.
  
  
  BACKGROUND
  The incidence of melanoma continues to rise. A proportion will present or recur with lymph node metastases (American Joint Committee on Cancer/Union for International Cancer Control stage III). To detect distant metastases, CT and/or FDG-PET are available. However, few studies have assessed their value and costs in stage III.
  
  
  METHODS
  All consecutive patients with melanoma with palpable, proven lymph node metastases (2003-2008) referred for examination with FDG-PET and CT were prospectively included. Sensitivity, specificity, and accuracy, and positive predictive value (PPV) and negative predictive value (NPV) were calculated. In economic evaluation, the costs of diagnostic work-up with and without FDG-PET and CT were compared.
  
  
  RESULTS
  Overall, 253 patients with melanoma were included. FDG-PET showed a higher sensitivity than CT: 86.1% compared with 78.2%. Specificity was higher for CT (93.7%) compared with FDG-PET (93.1%). Overall, FDG-PET showed a higher PPV and NPV. Cost-consequence analysis showed that adding CT (True-Positive upstaging in 61 patients) to diagnostic work-up decreased cost by 5.5%, adding FDG-PET (True-Positive upstaging in 68 patients) increased cost by 7.2%, and adding both (True-Positive upstaging in 78 patients) increased cost by 15.1%.
  
  
  CONCLUSIONS
  In this study, FDG-PET had higher sensitivity and predictive value, whereas CT had a higher specificity. Adding one of these diagnostic tools improved the staging of stage III patients with less than 10% cost increase. A proposal for stage-specific use of imaging modalities for clinicians caring for patients with melanoma is presented.
authors.affiliation: Department of Surgical Oncology, VU University Medical Centre, Amsterdam, The Netherlands.
authors.forename: Esther
authors.initials: E
authors.lastname: Bastiaannet
authors.forename: Carin A
authors.initials: CA
authors.lastname: Uyl-de Groot
authors.forename: Adrienne H
authors.initials: AH
authors.lastname: Brouwers
authors.forename: Eric J
authors.initials: EJ
authors.lastname: van der Jagt
authors.forename: Otto S
authors.initials: OS
authors.lastname: Hoekstra
authors.forename: Wim
authors.initials: W
authors.lastname: Oyen
authors.forename: Fred
authors.initials: F
authors.lastname: Verzijlbergen
authors.forename: Bart
authors.initials: B
authors.lastname: van Ooijen
authors.forename: John F
authors.initials: JF
authors.lastname: Thompson
authors.forename: Harald J
authors.initials: HJ
authors.lastname: Hoekstra
mesh_terms: D000328:Adult; D000368:Aged; D000369:Aged, 80 and over; D003362:Cost-Benefit Analysis; D005260:Female; D019788:Fluorodeoxyglucose F18 / Q000191:economics; D017721:Hospital Costs; D006801:Humans; D008207:Lymphatic Metastasis; D008297:Male; D008545:Melanoma / Q000175:diagnosis* / Q000191:economics / Q000473:pathology; D008875:Middle Aged; D061330:Multidetector Computed Tomography / Q000191:economics*; D009367:Neoplasm Staging; D009426:Netherlands; D049268:Positron-Emission Tomography / Q000191:economics*; D011237:Predictive Value of Tests; D011446:Prospective Studies; D019275:Radiopharmaceuticals / Q000191:economics; D012680:Sensitivity and Specificity; D012878:Skin Neoplasms / Q000175:diagnosis* / Q000191:economics / Q000473:pathology
chemical_list: D019275:Radiopharmaceuticals; D019788:Fluorodeoxyglucose F18