title: Economic analysis of FDG-PET-guided management of the neck after primary chemoradiotherapy for node-positive head and neck squamous cell carcinoma.
abstract: BACKGROUND
  The aim of this economic analysis was to model different strategies using pre-treatment nodal stage or nodal response assessment with CT or positron emission tomography (PET)/CT to determine the need for neck dissection.
  
  
  METHODS
  A cost-minimization analysis was developed on the basis of probability data from a prospective study of PET-guided management of the neck in patients achieving a complete response at the primary site. Costs were derived from our institution's activity-based clinical costing system. The effect of uncertainty was tested with sensitivity and scenario analyses including nationally representative cost data.
  
  
  RESULTS
  Strategies incorporating PET had a 7% rate for neck dissection compared with 44% for CT-guided and 90% for planned neck dissection. The cost per patient was A$16,502 for planned neck dissection, A$8014 for CT-guided, and A$2573 for PET-guided. A policy with PET used only for incomplete response on CT was the least-cost strategy (A$2111). Policies incorporating PET remained the most efficient for all sensitivity/scenario analyses.
  
  
  CONCLUSIONS
  The incorporation of PET/CT into nodal response assessment significantly reduced the number of unnecessary neck dissections and generated considerable cost savings in our cohort.
authors.affiliation: Division of Cancer Services, Princess Alexandra Hospital, Brisbane, Australia. david_pryor@health.qld.gov.au
authors.forename: David I
authors.initials: DI
authors.lastname: Pryor
authors.forename: Sandro V
authors.initials: SV
authors.lastname: Porceddu
authors.forename: Paul A
authors.initials: PA
authors.lastname: Scuffham
authors.forename: Jennifer A
authors.initials: JA
authors.lastname: Whitty
authors.forename: Paul A
authors.initials: PA
authors.lastname: Thomas
authors.forename: Bryan H
authors.initials: BH
authors.lastname: Burmeister
mesh_terms: D000328:Adult; D000368:Aged; D000369:Aged, 80 and over; D002294:Carcinoma, Squamous Cell / Q000175:diagnosis / Q000191:economics* / Q000628:therapy*; D059248:Chemoradiotherapy / Q000379:methods*; D005260:Female; D019788:Fluorodeoxyglucose F18; D006258:Head and Neck Neoplasms / Q000175:diagnosis / Q000191:economics* / Q000628:therapy*; D006801:Humans; D008207:Lymphatic Metastasis; D008297:Male; D008875:Middle Aged; D064847:Multimodal Imaging / Q000191:economics*; D037981:Neck Dissection / Q000191:economics; D049268:Positron-Emission Tomography / Q000191:economics*; D011446:Prospective Studies; D019275:Radiopharmaceuticals; D000077195:Squamous Cell Carcinoma of Head and Neck; D014057:Tomography, X-Ray Computed / Q000191:economics*
chemical_list: D019275:Radiopharmaceuticals; D019788:Fluorodeoxyglucose F18