Is FDG PET/CT cost-effective for pre-operation staging of potentially operative non-small cell lung cancer? - From Chinese healthcare system perspective.
OBJECTIVE
The remarkable morbidity and mortality of lung cancer in the large population address major economic challenges to Chinese healthcare system. This study aims to assess the cost-effectiveness of fluorodeoxyglucose positron emission tomography (FDG PET)/CT for staging patients with non-small cell lung cancer (NSCLC) in China.


METHODS
Management of potentially operative NSCLC was modeled on decision analysis employing data in China. The strategies compared were conventional CT staging (strategy A), additional PET/CT in all patients (strategy B) or only in patients with normal-sized lymph nodes on CT (strategy C). Published medical data for Chinese patients was extracted. The costs corresponded to reimbursement by Chinese public health provider in 2010. Uncertainly of employed parameters was calculated in sensitivity analysis.


RESULTS
Taking strategy A as baseline, the incremental cost-effectiveness ratio (ICER) of strategy B was 23,800RMB ($3500) per life year saved, which was acceptable in views of a developing country as China; while strategy C exhibited some loss of life years. Sensitivity analysis suggested the ICER (B-A) was raised more remarkably by a deterioration of PET specificity than by that of its sensitivity. The ICER was turned negative by PET specificity lower than 0.79. Economically, PET cost was proportional to the ICER (B-A), and decrease of palliative therapy cost could reduce both the ICER and overall cost.


CONCLUSIONS
The PET/CT strategy is potentially cost-effective for management of NSCLC in China. Patients with nodal-positive CT results are not suggested to be excluded from further PET/CT. Furthermore, maintaining high specificity of PET in clinical scenarios is crucial. Prospective trials are warranted to transfer these results into policy making.
Department of Nuclear Medicine, Renji Hospital, Shanghai Jiao Tong University, School of Medicine, China. wangyuting 330@163.com
Yu-ting
YT
Wang
Gang
G
Huang
D000293:Adolescent; D000328:Adult; D000368:Aged; D002289:Carcinoma, Non-Small-Cell Lung / Q000191:economics* / Q000473:pathology* / Q000601:surgery; D002648:Child; D002681:China / Q000453:epidemiology; D003362:Cost-Benefit Analysis / Q000706:statistics & numerical data; D005260:Female; D019788:Fluorodeoxyglucose F18 / Q000191:economics; D017048:Health Care Costs / Q000706:statistics & numerical data*; D006801:Humans; D008175:Lung Neoplasms / Q000175:diagnosis* / Q000191:economics / Q000601:surgery; D008297:Male; D008875:Middle Aged; D064847:Multimodal Imaging / Q000191:economics* / Q000706:statistics & numerical data; D009367:Neoplasm Staging; D049268:Positron-Emission Tomography; D011300:Preoperative Care / Q000191:economics / Q000706:statistics & numerical data; D015995:Prevalence; D011788:Quality of Life; D019275:Radiopharmaceuticals / Q000191:economics; D012307:Risk Factors; D016019:Survival Analysis; D015996:Survival Rate; D014057:Tomography, X-Ray Computed; D016896:Treatment Outcome; D055815:Young Adult
D019275:Radiopharmaceuticals; D019788:Fluorodeoxyglucose F18