title: Cost-effectiveness of positron emission tomography-CT in the evaluation of cancer of unknown primary of the head and neck.
abstract: BACKGROUND
  Positron emission tomography (PET)-CT is a useful diagnostic adjunct for cancer unknown primary (CUP) of the head and neck; however, the increased cost has not been justified with an economic evaluation in this patient population.
  
  
  METHODS
  A decision tree analysis was performed from the perspective of the third party payer. Primary outcome was cost per life year gained ($/LYG). The 2 comparative groups were: (1) PET-CT followed by panendoscopy versus (2) panendoscopy alone.
  
  
  RESULTS
  The incremental cost-effectiveness ratios for N1, N2, and N3 CUP were $369.83/LYG, $329.43/LYG, and $4900.28/LYG, respectively. The sensitivity analysis demonstrated a 96.8%, 97.1%, and 60.1% certainty that PET-CT is cost-effective for CUP with N1, N2, and N3 disease, respectively.
  
  
  CONCLUSIONS
  The use of PET-CT in patients with N1 and N2 CUP is the cost-effective choice. The cost-effectiveness in N3 CUP is questionable and should be used on an individual case basis.
authors.affiliation: Division of Otolaryngology - Head and Neck Surgery, Department of Surgery, University of Calgary, Calgary, Alberta.
authors.forename: Kristine A
authors.initials: KA
authors.lastname: Smith
authors.affiliation: Division of Otolaryngology - Head and Neck Surgery, Department of Surgery, University of Calgary, Calgary, Alberta.
authors.forename: Joseph C
authors.initials: JC
authors.lastname: Dort
authors.affiliation: Department of Otolaryngology - Head and Neck Surgery, Division of Cancer Care and Epidemiology, Queens Cancer Research Institute, Queens University, Ontario, Canada.
authors.forename: Stephen F
authors.initials: SF
authors.lastname: Hall
authors.affiliation: Division of Otolaryngology - Head and Neck Surgery, Department of Surgery, University of Calgary, Calgary, Alberta.
authors.forename: Luke
authors.initials: L
authors.lastname: Rudmik
mesh_terms: D003362:Cost-Benefit Analysis; D006258:Head and Neck Neoplasms / Q000175:diagnosis / Q000191:economics*; D006801:Humans; D037981:Neck Dissection / Q000191:economics* / Q000379:methods; D009382:Neoplasms, Unknown Primary / Q000175:diagnosis / Q000191:economics*; D009426:Netherlands; D049268:Positron-Emission Tomography / Q000191:economics / Q000379:methods; D011237:Predictive Value of Tests; D011788:Quality of Life; D012680:Sensitivity and Specificity; D016019:Survival Analysis; D014057:Tomography, X-Ray Computed / Q000191:economics / Q000379:methods
keywords: cost-effectiveness; head and neck cancer; positron emission tomography-CT; squamous cell carcinoma; unknown primary