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Impact of 18FFDG-PET/CT and Laparoscopy in Staging of Locally Advanced Gastric Cancer: A Cost Analysis in the Prospective Multicenter PLASTIC-Study.
de Jongh, Cas; van der Meulen, Miriam P; Gertsen, Emma C; Brenkman, Hylke J F; van Sandick, Johanna W; van Berge Henegouwen, Mark I; Gisbertz, Suzanne S; Luyer, Misha D P; Nieuwenhuijzen, Grard A P; van Lanschot, Jan J B; Lagarde, Sjoerd M; Wijnhoven, Bas P L; de Steur, Wobbe O; Hartgrink, Henk H; Stoot, Jan H M B; Hulsewe, Karel W E; Spillenaar Bilgen, Ernst Jan; van Det, Marc J; Kouwenhoven, Ewout A; Daams, Freek; van der Peet, Donald L; van Grieken, Nicole C T; Heisterkamp, Joos; van Etten, Boudewijn; van den Berg, Jan-Willem; Pierie, Jean-Pierre; Eker, Hasan H; Thijssen, Annemieke Y; Belt, Eric J T; van Duijvendijk, Peter; Wassenaar, Eelco; Wevers, Kevin P; Hol, Lieke; Wessels, Frank J; Haj Mohammad, Nadia; Frederix, Geert W J; van Hillegersberg, Richard; Siersema, Peter D; Vegt, Erik; Ruurda, Jelle P.
Affiliation
  • de Jongh C; Department of Surgery, Medical Oncology and Radiology, University Medical Center (UMC) Utrecht, Utrecht, The Netherlands.
  • van der Meulen MP; Julius Center for Health Sciences and Primary Care, UMC Utrecht, Utrecht, The Netherlands.
  • Gertsen EC; Department of Surgery, Medical Oncology and Radiology, University Medical Center (UMC) Utrecht, Utrecht, The Netherlands.
  • Brenkman HJF; Department of Surgery, Medical Oncology and Radiology, University Medical Center (UMC) Utrecht, Utrecht, The Netherlands.
  • van Sandick JW; Surgery and Nuclear Medicine Department, The Netherlands Cancer Institute-Antoni van Leeuwenhoek, Amsterdam, The Netherlands.
  • van Berge Henegouwen MI; Surgery Department, Amsterdam UMC, Location University of Amsterdam, Amsterdam, The Netherlands.
  • Gisbertz SS; Surgery and Pathology Department, Cancer Center Amsterdam, Amsterdam, The Netherlands.
  • Luyer MDP; Surgery Department, Amsterdam UMC, Location University of Amsterdam, Amsterdam, The Netherlands.
  • Nieuwenhuijzen GAP; Surgery and Pathology Department, Cancer Center Amsterdam, Amsterdam, The Netherlands.
  • van Lanschot JJB; Surgery Department, Catharina Hospital Eindhoven, Eindhoven, The Netherlands.
  • Lagarde SM; Surgery Department, Catharina Hospital Eindhoven, Eindhoven, The Netherlands.
  • Wijnhoven BPL; Surgery and Nuclear Medicine Department, Erasmus Medical Center UMC Rotterdam, Rotterdam, The Netherlands.
  • de Steur WO; Surgery and Nuclear Medicine Department, Erasmus Medical Center UMC Rotterdam, Rotterdam, The Netherlands.
  • Hartgrink HH; Surgery and Nuclear Medicine Department, Erasmus Medical Center UMC Rotterdam, Rotterdam, The Netherlands.
  • Stoot JHMB; Surgery Department, Leiden UMC, Leiden, The Netherlands.
  • Hulsewe KWE; Surgery Department, Leiden UMC, Leiden, The Netherlands.
  • Spillenaar Bilgen EJ; Surgery Department, Zuyderland MC, Sittard-Geleen, The Netherlands.
  • van Det MJ; Surgery Department, Zuyderland MC, Sittard-Geleen, The Netherlands.
  • Kouwenhoven EA; Surgery Department, Rijnstate Hospital, Arnhem, the Netherlands.
  • Daams F; Surgery Department, ZGT Hospital, Almelo, The Netherlands.
  • van der Peet DL; Surgery Department, ZGT Hospital, Almelo, The Netherlands.
  • van Grieken NCT; Surgery and Pathology Department, Cancer Center Amsterdam, Amsterdam, The Netherlands.
  • Heisterkamp J; Surgery and Pathology Department, Location Vrije University, Amsterdam UMC, Amsterdam, The Netherlands.
  • van Etten B; Surgery and Pathology Department, Cancer Center Amsterdam, Amsterdam, The Netherlands.
  • van den Berg JW; Surgery and Pathology Department, Location Vrije University, Amsterdam UMC, Amsterdam, The Netherlands.
  • Pierie JP; Surgery and Pathology Department, Cancer Center Amsterdam, Amsterdam, The Netherlands.
  • Eker HH; Surgery and Pathology Department, Location Vrije University, Amsterdam UMC, Amsterdam, The Netherlands.
  • Thijssen AY; Surgery Department, Elisabeth Twee-Steden Hospital, Tilburg, The Netherlands.
  • Belt EJT; Surgery Department, UMC Groningen, Groningen, The Netherlands.
  • van Duijvendijk P; Surgery Department, UMC Groningen, Groningen, The Netherlands.
  • Wassenaar E; Surgery Department, Medical Center Leeuwarden, Leeuwarden, The Netherlands.
  • Wevers KP; Surgery Department, Medical Center Leeuwarden, Leeuwarden, The Netherlands.
  • Hol L; Gastroenterology Department, Albert Schweitzer Hospital, Dordrecht, The Netherlands.
  • Wessels FJ; Gastroenterology Department, Albert Schweitzer Hospital, Dordrecht, The Netherlands.
  • Haj Mohammad N; Surgery Department, Gelre Hospitals, Apeldoorn, The Netherlands.
  • Frederix GWJ; Surgery Department, Gelre Hospitals, Apeldoorn, The Netherlands.
  • van Hillegersberg R; Surgery Department, Isala Hospital, Zwolle, The Netherlands.
  • Siersema PD; Gastroenterology Department, Maasstad Hospital, Rotterdam, The Netherlands.
  • Vegt E; Department of Surgery, Medical Oncology and Radiology, University Medical Center (UMC) Utrecht, Utrecht, The Netherlands.
  • Ruurda JP; Department of Surgery, Medical Oncology and Radiology, University Medical Center (UMC) Utrecht, Utrecht, The Netherlands.
Ann Surg Oncol ; 31(6): 4005-4017, 2024 Jun.
Article in En | MEDLINE | ID: mdl-38526832
ABSTRACT

BACKGROUND:

Unnecessary D2-gastrectomy and associated costs can be prevented after detecting non-curable gastric cancer, but impact of staging on treatment costs is unclear. This study determined the cost impact of 18F-fluorodeoxyglucose positron emission tomography/computed tomography (18FFDG-PET/CT) and staging laparoscopy (SL) in gastric cancer staging. MATERIALS AND

METHODS:

In this cost analysis, four staging strategies were modeled in a decision tree (1) 18FFDG-PET/CT first, then SL, (2) SL only, (3) 18FFDG-PET/CT only, and (4) neither SL nor 18FFDG-PET/CT. Costs were assessed on the basis of the prospective PLASTIC-study, which evaluated adding 18FFDG-PET/CT and SL to staging advanced gastric cancer (cT3-4 and/or cN+) in 18 Dutch hospitals. The Dutch Healthcare Authority provided 18FFDG-PET/CT unit costs. SL unit costs were calculated bottom-up. Gastrectomy-associated costs were collected with hospital claim data until 30 days postoperatively. Uncertainty was assessed in a probabilistic sensitivity analysis (1000 iterations).

RESULTS:

18FFDG-PET/CT costs were €1104 including biopsy/cytology. Bottom-up calculations totaled €1537 per SL. D2-gastrectomy costs were €19,308. Total costs per patient were €18,137 for strategy 1, €17,079 for strategy 2, and €19,805 for strategy 3. If all patients undergo gastrectomy, total costs were €18,959 per patient (strategy 4). Performing SL only reduced costs by €1880 per patient. Adding 18FFDG-PET/CT to SL increased costs by €1058 per patient; IQR €870-1253 in the sensitivity analysis.

CONCLUSIONS:

For advanced gastric cancer, performing SL resulted in substantial cost savings by reducing unnecessary gastrectomies. In contrast, routine 18FFDG-PET/CT increased costs without substantially reducing unnecessary gastrectomies, and is not recommended due to limited impact with major costs. TRIAL REGISTRATION NCT03208621. This trial was registered prospectively on 30-06-2017.
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Full text: 1 Database: MEDLINE Main subject: Stomach Neoplasms / Laparoscopy / Radiopharmaceuticals / Fluorodeoxyglucose F18 / Positron Emission Tomography Computed Tomography / Gastrectomy / Neoplasm Staging Limits: Female / Humans / Male Language: En Year: 2024 Type: Article
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Full text: 1 Database: MEDLINE Main subject: Stomach Neoplasms / Laparoscopy / Radiopharmaceuticals / Fluorodeoxyglucose F18 / Positron Emission Tomography Computed Tomography / Gastrectomy / Neoplasm Staging Limits: Female / Humans / Male Language: En Year: 2024 Type: Article