title: Does Routine Posttreatment PET/CT Add Value to the Care of Women With Locally Advanced Cervical Cancer?
abstract: The aim of this study was to determine the necessary reduction in recurrence rate that would make postchemoradiation positron emission tomography (PET)/computed tomography (CT) to direct completion hysterectomy for locally advanced cervical cancer (LACC) cost-effective.
  
  
  
  A decision model evaluated costs and recurrence rates of 2 posttreatment surveillance strategies in LACC: (1) routine surveillance without PET/CT and (2) PET/CT after 3 months to triage to completion hysterectomy. Incremental cost-effectiveness ratios were expressed in dollars per additional cancer recurrence avoided. Model parameters included expected rates of recurrence using each strategy, true- and false-positive rates of posttreatment PET/CT, and major complications of completion hysterectomy. From published data, we modeled an LACC baseline recurrence rate of 32%, PET/CT false-positive rate of 33%, and false-negative rate of 19%. We assumed that PET/CT revealed persistent local cervical cancer in 16% and progressive or distant disease in 6%. Costs of PET/CT, hysterectomy, and treatment for recurrence were based on Medicare reimbursements. A 50% salvage rate with hysterectomy was assumed and varied in sensitivity analysis.
  
  
  
  Routine use of PET/CT to direct completion hysterectomy was associated with a higher average cost ($16,579 vs $15,450) and a lower recurrence rate (26% vs 32%). The incremental cost-effectiveness ratio of PET was $20,761 per recurrence prevented. When the probability of recurrence after hysterectomy dropped to 25% or less, PET/CT was a dominant strategy.
  
  
  
  Routine use of PET/CT to determine which patients may benefit from a completion hysterectomy after chemoradiation for LACC has the potential to be highly cost-effective.
authors.affiliation: *Gynecologic Oncology Service, Department of Obstetrics and Gynecology, Murtha Cancer Center, Walter Reed National Military Medical Center, Bethesda, MD; †Department of Defense Gynecologic Cancer Center of Excellence, Women's Health Integrated Research Center at Inova Health System, Annandale, VA; ‡Division of Gynecologic Oncology, Duke Cancer Center, Durham, NC; and §Division of Gynecologic Oncology, Department of Obstetrics and Gynecology, San Antonio Military Medical Center, Fort Sam Houston, TX.
authors.forename: Neil T
authors.initials: NT
authors.lastname: Phippen
authors.forename: Laura J
authors.initials: LJ
authors.lastname: Havrilesky
authors.forename: Jason C
authors.initials: JC
authors.lastname: Barnett
authors.forename: Chad A
authors.initials: CA
authors.lastname: Hamilton
authors.forename: Michael P
authors.initials: MP
authors.lastname: Stany
authors.forename: William J
authors.initials: WJ
authors.lastname: Lowery
mesh_terms: D003362:Cost-Benefit Analysis; D003661:Decision Support Techniques; D005260:Female; D006801:Humans; D007044:Hysterectomy / Q000191:economics / Q000379:methods; D009364:Neoplasm Recurrence, Local / Q000000981:diagnostic imaging / Q000191:economics / Q000517:prevention & control; D000072078:Positron Emission Tomography Computed Tomography / Q000191:economics* / Q000379:methods*; D015203:Reproducibility of Results; D014481:United States; D002583:Uterine Cervical Neoplasms / Q000000981:diagnostic imaging* / Q000191:economics* / Q000473:pathology / Q000601:surgery