title: Cost-effectiveness analysis of routine surveillance imaging of patients with diffuse large B-cell lymphoma in first remission.
abstract: OBJECTIVE
  Surveillance imaging of asymptomatic patients with diffuse large B-cell lymphoma (DLBCL) in first remission remains controversial. A decision-analytic Markov model was developed to evaluate the cost-effectiveness of follow-up strategies following first-line immunochemotherapy.
  
  
  METHODS
  Three strategies were compared in 55-year-old patient cohorts: routine clinical follow-up without serial imaging, routine follow-up with biannual computed tomography (CT) scans for 2 years, or routine follow-up with biannual [(18)F]-fluorodeoxyglucose positron emission tomography-computed tomography (PET/CT) for 2 years. The baseline model favored imaging-based strategies by associating asymptomatic imaging-detected relapses with improved clinical outcomes. Lifetime costs, quality-adjusted life years (QALYs), and incremental cost-effectiveness ratios (ICERs) were calculated for each surveillance strategy.
  
  
  RESULTS
  Surveillance strategies utilizing 2 years of routine CT or PET/CT scans were associated with minimal survival benefit when compared with clinical follow-up without routine imaging (life-years gained: CT, 0.03 years; PET/CT, 0.04 years). The benefit of imaging-based follow-up remained small after quality-of-life adjustments (CT, 0.020 QALYs; PET/CT, 0.025 QALYs). Costs associated with imaging-based surveillance strategies are considerable; ICERs for imaging strategies compared with clinical follow-up were $164,960/QALY (95% CI, $116,510 to $766,930/QALY) and $168,750/QALY (95% CI, $117,440 to 853,550/QALY) for CT and PET/CT, respectively. Model conclusions were robust and remained stable on one-way and probabilistic sensitivity analyses.
  
  
  CONCLUSIONS
  Our cost-effectiveness analysis suggests surveillance imaging of asymptomatic DLBCL patients in remission offers little clinical benefit at substantial economic costs.
authors.affiliation: All authors: University of Pennsylvania, Philadelphia, PA. scott.huntington@uphs.upenn.edu.
authors.forename: Scott F
authors.initials: SF
authors.lastname: Huntington
authors.affiliation: All authors: University of Pennsylvania, Philadelphia, PA.
authors.forename: Jakub
authors.initials: J
authors.lastname: Svoboda
authors.affiliation: All authors: University of Pennsylvania, Philadelphia, PA.
authors.forename: Jalpa A
authors.initials: JA
authors.lastname: Doshi
mesh_terms: D003362:Cost-Benefit Analysis; D003661:Decision Support Techniques; D019788:Fluorodeoxyglucose F18 / Q000191:economics; D017048:Health Care Costs; D006801:Humans; D007167:Immunotherapy / Q000379:methods; D016403:Lymphoma, Large B-Cell, Diffuse / Q000175:diagnosis* / Q000000981:diagnostic imaging / Q000191:economics* / Q000628:therapy; D008390:Markov Chains; D008875:Middle Aged; D018803:Models, Economic; D064847:Multimodal Imaging / Q000191:economics; D049268:Positron-Emission Tomography / Q000191:economics*; D011237:Predictive Value of Tests; D019057:Quality-Adjusted Life Years; D019275:Radiopharmaceuticals / Q000191:economics; D012074:Remission Induction; D013997:Time Factors; D014057:Tomography, X-Ray Computed / Q000191:economics*; D016896:Treatment Outcome
chemical_list: D019275:Radiopharmaceuticals; D019788:Fluorodeoxyglucose F18