ABSTRACT
BACKGROUND AND OBJECTIVES: Correct identification of estrogen receptor (ER) status in breast cancer (BC) is crucial to optimize treatment; however, standard of care, involving biopsy and immunohistochemistry (IHC), and other diagnostic tools such as 2-deoxy-2-[18F]fluoro-D-glucose or 2-[18F]fluoro-2-deoxy-D-glucose ([18F]FDG), can yield inconclusive results. 16α-[18F]fluoro-17ß-fluoroestradiol ([18F]FES) can be a powerful tool, providing high diagnostic accuracy of ER-positive disease. The aim of this study was to estimate the budget impact and cost-effectiveness of adding [18F]FES PET/CT to biopsy/IHC in the determination of ER-positive status in metastatic (mBC) and recurrent breast cancer (rBC) in the United States (US). METHODS: An Excel-based decision tree, combined with a Markov model, was developed to estimate the economic consequences of adding [18F]FES PET/CT to biopsy/IHC for determining ER-positive status in mBC and rBC over 5 years. Scenario A, where the determination of ER-positive status is carried out solely through biopsy/IHC, was compared to scenario B, where [18F]FES PET/CT is used in addition to biopsy/IHC. RESULTS: The proportion of true positive and true negative test results increased by 0.2 to 8.0 percent points in scenario B compared to scenario A, while re-biopsies were reduced by 94% to 100%. Scenario B resulted in cost savings up to 142 million dollars. CONCLUSIONS: Adding [18F]FES PET/CT to biopsy/IHC may increase the diagnostic accuracy of the ER status, especially when a tumor sample cannot be obtained, or the risk of a biopsy-related complication is high. Therefore, adding [18F]FES PET/CT to biopsy/IHC would have a positive impact on US clinical and economic outcomes.
Subject(s)
Breast Neoplasms , Cost-Benefit Analysis , Positron Emission Tomography Computed Tomography , Receptors, Estrogen , Female , Humans , Middle Aged , Breast Neoplasms/pathology , Breast Neoplasms/diagnostic imaging , Breast Neoplasms/economics , Breast Neoplasms/metabolism , Breast Neoplasms/diagnosis , Estradiol/analogs & derivatives , Fluorodeoxyglucose F18 , Neoplasm Metastasis , Neoplasm Recurrence, Local/pathology , Neoplasm Recurrence, Local/diagnostic imaging , Positron Emission Tomography Computed Tomography/economics , Positron Emission Tomography Computed Tomography/methods , Radiopharmaceuticals , Receptors, Estrogen/metabolism , United States , Fluorine Radioisotopes/metabolism , Fluorine Radioisotopes/pharmacologyABSTRACT
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.
Subject(s)
Fluorodeoxyglucose F18 , Gastrectomy , Laparoscopy , Neoplasm Staging , Positron Emission Tomography Computed Tomography , Radiopharmaceuticals , Stomach Neoplasms , Stomach Neoplasms/pathology , Stomach Neoplasms/surgery , Stomach Neoplasms/diagnostic imaging , Stomach Neoplasms/economics , Humans , Laparoscopy/economics , Laparoscopy/methods , Positron Emission Tomography Computed Tomography/economics , Positron Emission Tomography Computed Tomography/methods , Prospective Studies , Gastrectomy/economics , Fluorodeoxyglucose F18/economics , Radiopharmaceuticals/economics , Cost-Benefit Analysis , Follow-Up Studies , Prognosis , Costs and Cost Analysis , Male , FemaleABSTRACT
INTRODUCTION AND OBJECTIVE: Next-generation imaging (NGI) tests, such as choline PET/CT and PSMA PET, have shown to increase sensitivity in the detection of nodal and metastatic disease in prostate cancer. However, their use implies an increase in diagnostic costs compared to conventional imaging (CI) tests such as CT and bone scan. The aim of our study was to determine which diagnostic pathway is more cost-effective in high-risk prostate cancer. MATERIAL AND METHOD: Cost-effectiveness analysis of the available imaging tests (CI, Choline/PSMA PET) for the staging of high-risk prostate cancer. Sensitivity and specificity were estimated based on published evidence, and costs were collected from the Management Department. In order to carry out a cost-effectiveness analysis, five diagnostic pathways were proposed estimating the accurate diagnoses. RESULTS: PSMA PET was the most accurate diagnostic option. The CI diagnostic workup was the most economical and CI+PSMA the most expensive. Analyzing the diagnostic cost-effectiveness ratio, CI+PSMA proved to be the most expensive (5627.30 per correct diagnosis) followed by PET PSMA (4987.11), choline (4599.84) and CI (4444.22). CONCLUSIONS: PSMA PET is the most accurate strategy in staging distant disease in patients with high-risk prostate cancer. Radiotracer uptake tests such as CI have been shown to be the most cost-effective option, followed by choline and PSMA.
Subject(s)
Cost-Benefit Analysis , Neoplasm Staging , Prostatic Neoplasms , Male , Humans , Prostatic Neoplasms/diagnostic imaging , Prostatic Neoplasms/pathology , Positron Emission Tomography Computed Tomography/economics , Positron Emission Tomography Computed Tomography/methods , Choline/analogs & derivatives , Costs and Cost Analysis , Risk AssessmentABSTRACT
AIM: To assess the rates of nodal and metastatic disease and change in management when staging part-solid T1 lung adenocarcinomas using integrated 2-[18F]-fluoro-2-deoxy-d-glucose (FDG) positron-emission tomography (PET)-computed tomography (CT) in a UK population. MATERIALS AND METHODS: This was a retrospective review of PET-CT examinations performed to stage radiologically suspected T1 part-solid lung adenocarcinoma (n=58) from two different centres. Rates of detection of nodal and metastatic disease, change in management, and final patient outcome were recorded. RESULTS: PET-CT changed the stage in one patient from N0 to N1. It did not change final management in any patient. CONCLUSIONS: In this UK population, PET-CT had minimal additional diagnostic benefit in staging patients with T1 part-solid lung adenocarcinoma. Especially given its cost, the inclusion of PET-CT for this indication in guidelines should be reviewed.
Subject(s)
Adenocarcinoma of Lung/diagnostic imaging , Fluorodeoxyglucose F18 , Lung Neoplasms/diagnostic imaging , Positron Emission Tomography Computed Tomography/methods , Radiopharmaceuticals , Adenocarcinoma of Lung/pathology , Aged , Aged, 80 and over , Female , Humans , Lung Neoplasms/pathology , Male , Middle Aged , Neoplasm Staging , Positron Emission Tomography Computed Tomography/economics , Retrospective Studies , United KingdomABSTRACT
BACKGROUND: Primary hyperparathyroidism historically necessitated bilateral neck exploration to remove abnormal parathyroid tissue. Improved localization allows for focused parathyroidectomy with lower complication risks. Recently, positron emission tomography using radiolabeled 18F-fluorocholine demonstrated high accuracy in detecting these lesions, but its cost-effectiveness has not been studied in the United States. METHODS: A decision tree modeled patients who underwent parathyroidectomy for primary hyperparathyroidism using single preoperative localization modalities: (1) positron emission tomography using radiolabeled 18F-fluorocholine, (2) 4-dimensional computed tomography, (3) ultrasound, and (4) sestamibi single photon emission computed tomography (SPECT). All patients underwent either focused parathyroidectomy versus bilateral neck exploration, with associated cost ($) and clinical outcomes measured in quality-adjusted life-years gained. Model parameters were informed by literature review and Medicare costs. Incremental cost-utility ratios were calculated in US dollars/quality-adjusted life-years gained, with a willingness-to-pay threshold set at $100,000/quality-adjusted life-year. One-way, 2-way, and threshold sensitivity analyses were performed. RESULTS: Positron emission tomography using radiolabeled 18F-fluorocholine gained the most quality-adjusted life-years (23.9) and was the costliest ($2,096), with a total treatment cost of $11,245 or $470/quality-adjusted life-year gained. Sestamibi single photon emission computed tomography and ultrasound were dominated strategies. Compared with 4-dimentional computed tomography, the incremental cost-utility ratio for positron emission tomography using radiolabeled 18F-fluorocholine was $91,066/quality-adjusted life-year gained in our base case analysis, which was below the willingness-to-pay threshold. In 1-way sensitivity analysis, the incremental cost-utility ratio was sensitive to test accuracy, positron emission tomography using radiolabeled 18F-fluorocholine price, postoperative complication probabilities, proportion of bilateral neck exploration patients needing overnight hospitalization, and life expectancy. CONCLUSION: Our model elucidates scenarios in which positron emission tomography using radiolabeled 18F-fluorocholine can potentially be a cost-effective imaging option for primary hyperparathyroidism in the United States. Further investigation is needed to determine the maximal cost-effectiveness for positron emission tomography using radiolabeled 18F-fluorocholine in selected populations.
Subject(s)
Cost-Benefit Analysis/statistics & numerical data , Hyperparathyroidism, Primary/diagnosis , Parathyroid Glands/diagnostic imaging , Parathyroid Neoplasms/diagnosis , Positron-Emission Tomography/economics , Choline/administration & dosage , Choline/analogs & derivatives , Choline/economics , Fluorine Radioisotopes/administration & dosage , Fluorine Radioisotopes/economics , Four-Dimensional Computed Tomography/economics , Humans , Hyperparathyroidism, Primary/economics , Hyperparathyroidism, Primary/etiology , Hyperparathyroidism, Primary/surgery , Medicare/economics , Medicare/statistics & numerical data , Models, Economic , Parathyroid Glands/pathology , Parathyroid Glands/surgery , Parathyroid Neoplasms/complications , Parathyroid Neoplasms/economics , Parathyroid Neoplasms/surgery , Parathyroidectomy , Positron Emission Tomography Computed Tomography/economics , Positron-Emission Tomography/methods , Preoperative Care/economics , Preoperative Care/methods , Quality-Adjusted Life Years , Radiopharmaceuticals/administration & dosage , Radiopharmaceuticals/economics , Sensitivity and Specificity , Technetium Tc 99m Sestamibi/administration & dosage , Technetium Tc 99m Sestamibi/economics , Ultrasonography/economics , United StatesABSTRACT
INTRODUCTION: To identify the subset of patients with de novo nasopharyngeal carcinoma (NPC) for whom [18F] fluorodeoxyglucose positron emission tomography and computed tomography (18F-FDG PET/CT) should be recommended, and to determine whether PET/CT is a cost-effective decision for precise M staging in endemic areas. MATERIALS AND METHODS: Retrospective analysis of data of 4469 patients diagnosed with de novo NPC between January 2014 and December 2019. The detection rate of distant metastasis was compared between different groups. Univariate and multiple logistic regression analysis was applied to identify the risk factors for distant metastasis. The cost-effectiveness of the diagnostic strategies was assessed. RESULTS: The detection rate of distant metastasis in the whole cohort was 5.46%. In multivariate analysis, male sex, T3-4 stage, N2-3 stage, and high plasma Epstein-Barr virus (EBV) DNA (≥ 14,650 copies/mL) were risk factors for distant metastases. NPC patients with T3-4 stage combined with N2-3 stage, high EBV DNA combined with male sex, or N2-3 stage combined with high EBV DNA were defined as recommended group with relatively higher tendency for metastasis. Distant metastasis incidence in recommended group and unrecommended group were 10.25% and 1.75%, respectively (P < 0.001). In the recommended group, PET/CT significantly improved the detection rate of distant metastasis (13.25% vs 9.02%, P = 0.005). Cost-effectiveness analysis revealed that additional cost for every one percent increase in distant metastasis detection rate was $22,785.58 in the recommended group (< Willingness-to-pay (WTP) threshold of $32,700.00) and $310,912.90 in the unrecommended group. CONCLUSIONS: In patients with de novo NPC, the tendency for metastasis can be predicted based on clinical parameters. 18F-FDG PET/CT should be selectively recommended for the subset of patients with a relatively higher tendency for metastasis.
Subject(s)
Endemic Diseases/statistics & numerical data , Epstein-Barr Virus Infections/complications , Fluorodeoxyglucose F18/metabolism , Herpesvirus 4, Human/genetics , Nasopharyngeal Carcinoma/secondary , Nasopharyngeal Neoplasms/pathology , Positron Emission Tomography Computed Tomography/methods , Adolescent , Adult , Aged , Aged, 80 and over , Child , Child, Preschool , DNA, Viral/analysis , DNA, Viral/genetics , Endemic Diseases/economics , Epstein-Barr Virus Infections/virology , Female , Herpesvirus 4, Human/isolation & purification , Humans , Male , Middle Aged , Nasopharyngeal Carcinoma/diagnostic imaging , Nasopharyngeal Carcinoma/economics , Nasopharyngeal Carcinoma/virology , Nasopharyngeal Neoplasms/diagnostic imaging , Nasopharyngeal Neoplasms/economics , Nasopharyngeal Neoplasms/virology , Positron Emission Tomography Computed Tomography/economics , Prognosis , Radiopharmaceuticals/metabolism , Retrospective Studies , Young AdultABSTRACT
BACKGROUND: Lung cancer screening in high-risk population increases the proportion of patients diagnosed at a resectable stage. AIMS: To optimize the selection criteria and quality indicators for lung cancer screening by low-dose CT (LDCT) in the Czech population of high-risk individuals. To compare the influence of screening on the stage of lung cancer at the time of the diagnosis with the stage distribution in an unscreened population. To estimate the impact on life-years lost according to the stage-specific cancer survival and stage distribution in the screened population. To calculate the cost-effectiveness of the screening program. METHODS: Based on the evidence from large national trials - the National Lung Screening Trial in the USA (NLST), the NELSON study, the recent recommendations of the Fleischner society, the American College of Radiology, and I-ELCAP action group, we developed a protocol for a single-arm prospective study in the Czech Republic for the screening of high-risk asymptomatic individuals. The study commenced in August 2020. RESULTS: The inclusion criteria are: age 55 to 74 years; smoking: ≥30 pack-years; smoker or ex-smoker <15 years; performance status (0-1). The screening timepoints are at baseline and 1 year. The LDCT acquisition has a target CTDIvol ≤0.5mGy and effective dose ≤0.2mSv for a standard-size patient. The interpretation of findings is primarily based on nodule volumetry, volume doubling time (and related risk of malignancy). The management includes follow-up LDCT, contrast enhanced CT, PET/CT, tissue sampling. The primary outcome is the number of cancers detected at a resectable stage, secondary outcomes include the average cost per diagnosis of lung cancer, the number, cost, complications of secondary examinations, and the number of potentially important secondary findings. CONCLUSIONS: A study protocol for early detection of lung cancer in Czech high-risk asymptomatic individuals (ELEGANCE) study using LDCT has been described.
Subject(s)
Asymptomatic Diseases , Early Detection of Cancer/methods , Lung Neoplasms/diagnosis , Aged , Asymptomatic Diseases/economics , Biopsy/economics , Biopsy/methods , Cost-Benefit Analysis , Czech Republic , Early Detection of Cancer/economics , Female , Humans , Lung/pathology , Lung Neoplasms/economics , Lung Neoplasms/etiology , Male , Middle Aged , Neoplasm Staging/economics , Neoplasm Staging/methods , Patient Selection , Positron Emission Tomography Computed Tomography/economics , Positron Emission Tomography Computed Tomography/methods , Prospective Studies , Quality-Adjusted Life Years , Respiratory Function Tests/economics , Respiratory Function Tests/methods , Risk Assessment/economics , Risk Assessment/methods , Risk Factors , Tomography, X-Ray Computed/economics , Tomography, X-Ray Computed/methodsABSTRACT
BACKGROUND: Although many patients with locally advanced rectal cancer undergo restaging imaging after neoadjuvant chemoradiotherapy and before surgery, the benefit of this practice is unclear. The purpose of this study was to examine the impact of reimaging on outcomes. MATERIALS AND METHODS: We performed a retrospective analysis of consecutive patients with stage 2 and 3 rectal adenocarcinoma treated with neoadjuvant chemoradiotherapy between May 2005 and April 2018. Patient and disease characteristics, imaging, treatment, and oncologic outcomes were compared between those who underwent restaging and those who went directly to surgery. Predictors of outcomes and cost effectiveness of restaging were determined. RESULTS: Of 224 patients, 146 underwent restaging. Six restaged patients had findings leading to a change in management. There was no difference in freedom from recurrence (P = 0.807) and overall survival (P = 0.684) based on restaging. Pretreatment carcinoembryonic antigen level >3 ng/mL (P = 0.010), clinical T stage 4 (P = 0.016), and pathologic T4 (P = 0.047) and N2 (P = 0.002) disease increased the risk of death, whereas adjuvant chemotherapy decreased the risk of death (P < 0.001) on multivariate analysis. Disease recurrence was lower with pelvic exenteration (P = 0.005) and in females (P = 0.039) and higher with pathologic N2 (P = 0.003) and N3 (P = 0.002) disease. The average cost of reimaging is $40,309 per change in management; however, $45 is saved per patient when downstream surgical costs are considered. CONCLUSIONS: Imaging restaging after neoadjuvant chemoradiotherapy in patients with locally advanced rectal cancer rarely changes treatment and does not improve survival. In a subset of patients at higher risk for worse outcome, reimaging may be beneficial.
Subject(s)
Adenocarcinoma/diagnosis , Neoadjuvant Therapy/methods , Neoplasm Recurrence, Local/epidemiology , Rectal Neoplasms/diagnosis , Rectum/diagnostic imaging , Adenocarcinoma/mortality , Adenocarcinoma/pathology , Adenocarcinoma/therapy , Adult , Aged , Aged, 80 and over , Chemoradiotherapy, Adjuvant , Cost Savings , Cost-Benefit Analysis , Disease-Free Survival , Female , Humans , Kaplan-Meier Estimate , Magnetic Resonance Imaging/economics , Male , Middle Aged , Neoplasm Recurrence, Local/diagnosis , Neoplasm Recurrence, Local/prevention & control , Neoplasm Staging/economics , Neoplasm Staging/methods , Positron Emission Tomography Computed Tomography/economics , Proctectomy/economics , Prospective Studies , Rectal Neoplasms/mortality , Rectal Neoplasms/pathology , Rectal Neoplasms/therapy , Rectum/drug effects , Rectum/radiation effects , Rectum/surgery , Retrospective Studies , Tumor Burden/drug effects , Tumor Burden/radiation effectsABSTRACT
BACKGROUND: The diagnostic performance of 18F-sodium fluoride positron emission tomography/computed tomography (PET/CT) (NaF), 18F-fluorocholine PET/CT (FCH) and diffusion-weighted whole-body magnetic resonance imaging (DW-MRI) in detecting bone metastases in prostate cancer (PCa) patients with first biochemical recurrence (BCR) has already been published, but their cost-effectiveness in this indication have never been compared. METHODS: We performed trial-based and model-based economic evaluations. In the trial, PCa patients with first BCR after previous definitive treatment were prospectively included. Imaging readings were performed both on-site by local specialists and centrally by experts. The economic evaluation extrapolated the diagnostic performances of the imaging techniques using a combination of a decision tree and Markov model based on the natural history of PCa. The health states were non-metastatic and metastatic BCR, non-metastatic and metastatic castration-resistant prostate cancer and death. The state-transition probabilities and utilities associated with each health state were derived from the literature. Real costs were extracted from the National Cost Study of hospital costs and the social health insurance cost schedule. RESULTS: There was no significant difference in diagnostic performance among the 3 imaging modalities in detecting bone metastases. FCH was the most cost-effective imaging modality above a threshold incremental cost-effectiveness ratio of 3000/QALY when imaging was interpreted by local specialists and 9000/QALY when imaging was interpreted by experts. CONCLUSIONS: FCH had a better incremental effect on QALY, independent of imaging reading and should be preferred for detecting bone metastases in patients with biochemical recurrence of prostate cancer. TRIAL REGISTRATION: NCT01501630. Registered 29 December 2011.
Subject(s)
Bone Neoplasms/diagnostic imaging , Bone Neoplasms/secondary , Choline/analogs & derivatives , Neoplasm Recurrence, Local/diagnostic imaging , Prostatic Neoplasms/diagnostic imaging , Sodium Fluoride/administration & dosage , Aged , Aged, 80 and over , Choline/administration & dosage , Choline/economics , Cost-Benefit Analysis , Decision Trees , Diffusion Magnetic Resonance Imaging/economics , France , Humans , Male , Markov Chains , Middle Aged , Models, Economic , Positron Emission Tomography Computed Tomography/economics , Prospective Studies , Sensitivity and Specificity , Sodium Fluoride/economicsABSTRACT
Men treated for prostate cancer with curative intent face a recurrence rate of up to 53% at 10 years. 68Ga-PSMA imaging is a new technique that can more accurately stage cancer recurrences and facilitate personalised treatment. We evaluated the cost-effectiveness of 68Ga-PSMA PET/MRI for staging men with prostate cancer biochemical recurrence. A cost-effectiveness analysis using a decision-analytic model with Markov chains was constructed. 68Ga-PSMA PET/MRI was compared with usual care in staging of men with suspected prostate cancer recurrence. Men with biochemical recurrence from a study in Brisbane, Australia (n = 30) provided key estimates for the model. The primary outcomes were health system costs and years of life (survival) over 10 years. Deterministic and probabilistic sensitivity analyses were undertaken to address uncertainty in model estimates. On average, a strategy of 68Ga-PSMA was expected to cost AU$56 961(US$39 426) and produce 7.48 life years compared with AU$64 499 (US$44 667) and 7.41 life years in usual care. Therefore, 68Ga-PSMA was potentially cost saving (- AU$7 592 95% UI - $24 846, $7 825) (- US$5 258) and slightly more effective 0.07 life years (95% UI - 0.01, 0.16). The likelihood that 68Ga-PSMA strategy was cost-effective at acceptable thresholds was 87%. The findings were sensitive to the lesion detection rate of the 68Ga-PSMA strategy (52-75%) and the cost of follow up in usual care (AU$1 947 to $2 635). In this exploratory economic evaluation, using 68Ga-PSMA PET/MRI to detect prostate cancer recurrence appears to be cost-effective relative to usual care.
Subject(s)
Cost-Benefit Analysis , Magnetic Resonance Imaging/economics , Multimodal Imaging/economics , Neoplasm Recurrence, Local/diagnosis , Positron Emission Tomography Computed Tomography/economics , Prostatic Neoplasms/diagnosis , Adult , Androgen Antagonists/therapeutic use , Australia/epidemiology , Chemoradiotherapy, Adjuvant , Clinical Decision-Making/methods , Cost Savings , Disease-Free Survival , Gallium Isotopes , Gallium Radioisotopes , Health Care Costs/statistics & numerical data , Humans , Kallikreins/blood , Magnetic Resonance Imaging/methods , Male , Membrane Glycoproteins , Multimodal Imaging/methods , Neoplasm Recurrence, Local/blood , Neoplasm Recurrence, Local/mortality , Neoplasm Recurrence, Local/therapy , Organometallic Compounds , Pilot Projects , Positron Emission Tomography Computed Tomography/methods , Progression-Free Survival , Prostate/diagnostic imaging , Prostate/pathology , Prostate/surgery , Prostate-Specific Antigen/blood , Prostatectomy/methods , Prostatic Neoplasms/blood , Prostatic Neoplasms/mortality , Prostatic Neoplasms/therapy , Quality-Adjusted Life Years , Sensitivity and SpecificityABSTRACT
BACKGROUND: Outcomes of extended pelvic lymph node dissection (ePLND) show that only 16% of prostate cancer (PCa) patients harbour lymph node (LN) metastases. Ga-68 prostate-specific membrane antigen (PSMA) positron emission tomography/computed tomography (PET/CT) and nano magnetic resonance imaging (nano-MRI) might be noninvasive alternatives for ePLND; however, it remains uncertain whether they are cost-effective. OBJECTIVE: To develop an interactive model to determine the cost-effectiveness of 68Ga PSMA PET/CT and nano-MRI as compared with ePLND for the detection of pelvic LN metastases in patients with intermediate- to high-risk PCa. DESIGN, SETTING, AND PARTICIPANTS: Decision tree with state transition model for men with intermediate- to high-risk PCa. Input data was derived from systematic literature searches. OUTCOME MEASUREMENTS AND STATISTICAL ANALYSIS: Quality-adjusted life years (QALYs) and healthcare costs were modelled over lifetime. Sensitivity analyses were used to assess uncertainty. RESULTS AND LIMITATIONS: Assuming 100% sensitivity of ePLND, no QALY loss after ePLND, and no treatment improvement due to imaging, the PSMA PET/CT and nano-MRI strategies seem to be less expensive per patient (3047 and 2738, respectively) and result in loss of QALYs (0.07 and 0.03, respectively) compared with the ePLND strategy. PSMA PET/CT and nano-MRI are both cost saving and more effective when ePLND has a sensitivity of ≤60% and ≤84%, ePLND results in a QALY loss of 0.060 and 0.024 over lifetime, or the imaging techniques reduce recurrences by 26% and 8%, respectively. CONCLUSIONS: PSMA PET/CT and nano-MRI seem to be cost-effective compared with ePLND since they save cost, but at the possible expense of a small QALY loss. Our interactive model provides insight into the influence of important model parameters on the cost effectiveness of 68Ga PSMA PET/CT and nano-MRI, and the opportunity for updating the cost effectiveness when new evidence becomes available. PATIENT SUMMARY: We developed an interactive model that can be used in shared decision making regarding the use of extended pelvic lymph node dissection, 68Ga prostate-specific membrane antigen positron emission tomography/computed tomography, or nano magnetic resonance imaging for lymph node staging in individual patients with intermediate- to high-risk prostate cancer. Owing to remaining uncertainty, we cannot yet give advice about the use of these techniques.
Subject(s)
Cost-Benefit Analysis , Edetic Acid/analogs & derivatives , Lymphatic Metastasis/diagnostic imaging , Magnetic Resonance Imaging/economics , Magnetic Resonance Imaging/methods , Models, Economic , Oligopeptides , Positron Emission Tomography Computed Tomography/economics , Positron Emission Tomography Computed Tomography/methods , Prostatic Neoplasms/pathology , Radiopharmaceuticals , Gallium Isotopes , Gallium Radioisotopes , Humans , Lymph Node Excision , Male , Nanotechnology , PelvisABSTRACT
BACKGROUND: The aim of this study was, from the Chinese healthcare perspective, to assess the cost-effectiveness of positron-emission tomography-computed tomography (PET-CT) with F-fluorodeoxyglucose (F-FDG) in preoperation staging for nonsmall-cell lung cancer (NSCLC) with resected monometastatic disease based on a retrospective study. This study was conducted from January 2017 to February 2019 at an academic hospital. METHODS: A Markov model and 3 decision-tree models were designed to calculate the long-term medical costs, outcomes, and incremental cost-effectiveness ratios (ICERs) of the 2 diagnostic strategies (PET-CT and conventional CT). Model robustness was assessed in sensitivity analyses. RESULTS: For the base-case analysis, preoperative PET-CT evaluation for NSCLC with resected monometastatic disease provided an additional 1.475, 2.129, and 2.412 life-years (LYs), in the time horizon of 10-, 20-, and 30-year, respectively, and the ICERs for the PET-CT group compared with the conventional CT group were $1153, $1393, and $1430 per LY, separately. The acceptability curves demonstrated that when the willingness-to-pay (WTP) thresholds ranged from $500 to $3000/LY, the probability of cost-effectiveness changed varied dramatically, and at WTPâ>â$3000, the probability that the PET-CT group achieved cost-effectiveness was 100%. Sensitivity analyses suggested that the models we designed were robust. CONCLUSION: Compared with conventional CT scan, preoperative F-FDG PET-CT evaluation for patients with resected monometastatic NSCLC is cost-effective from the Chinese healthcare perspective. Preoperative F-FDG PET-CT evaluation should be popularized for patients with resected monometastatic NSCLC.
Subject(s)
Carcinoma, Non-Small-Cell Lung/diagnostic imaging , Lung Neoplasms/diagnostic imaging , Positron Emission Tomography Computed Tomography/economics , China , Cost-Benefit Analysis , Decision Trees , Humans , Lymph Nodes/diagnostic imaging , Markov Chains , Neoplasm Staging/instrumentation , Preoperative Care/economics , Preoperative Care/methods , Retrospective StudiesABSTRACT
El cáncer de pulmón es una neoplasia maligna bastante común. Un diagnóstico precoz y una estadificación y re-estadificación confiables, con el objetivo de detectar recaídas tanto locales como distantes, son de suma importancia en la planificación del manejo terapéutico. La evaluación diagnóstica de los pacientes con cáncer de pulmón generalmente incluye imágenes convencionales (radiografía de tórax, TC con contraste, gammagrafía ósea) y, más recientemente, PET/TC con 18F-FDG. El gran avance en el manejo del cáncer de pulmón derivado de la PET/TC con 18F-FDG proporciona información tanto metabólica como anatómica (mejor localización): existe una gran evidencia en la literatura que demuestra su utilidad en a) caracterizar nódulos solitarios benignos versus malignos, b) estadificación del cáncer de pulmón y re-estadificación, c) guía del tipo de terapia, d) seguimiento de la respuesta al tratamiento y e) predicción de resultados. En particular, gracias a su especificidad en la diferenciación de la recidiva con avidez por 18F-FDG de los cambios postquirúrgicos o de la fibrosis posradiación (que no captan 18F-FDG), la PET/TC puede detectar una enfermedad recurrente después del tratamiento inicial y (siendo una técnica de cuerpo completo) demuestra una alta precisión en la detección de metástasis a distancia o tumores secundarios. En conclusión, la PET/TC con 18F-FDG se puede considerar un método altamente preciso y confiable para estadificar y re-estadificar el cáncer de pulmón, y es muy eficaz para guiar terapias personalizadas
Lung cancer is a fairly common malignancy. An early diagnosis and a reliable staging and re-staging with the aim to detect both local and distant relapse are of utmost importance in planning the therapeutic management. The imaging diagnostic work-up of patients with lung cancer usually includes conventional imaging (chest X-ray, contrast-enhanced CT, bone scan) and more recently 18F-FDG PET/CT. Great advances in the management of lung cancer are based on the information provided by 18F-FDG PET/CT, as it supplies both metabolic and anatomic information (better localisation). There is vast evidence in the literature demonstrating its utility in (a) characterising benign versus malignant solitary nodules, (b) staging and re-staging lung cancer, (c) guiding the type of therapy, (d) monitoring treatment response and (e) predicting outcome. In particular, given its specificity in differentiating 18F-FDG-avid relapse from post-surgical changes or post-radiation fibrosis (which do not take up 18F-FDG), PET/CT can detect recurrent disease after initial treatment and (being a whole-body technique) has demonstrated high accuracy in the detection of distant metastases or secondary tumours. In conclusion, 18F-FDG PET/CT can be considered a highly accurate and reliable method for staging and re-staging lung cancer, and is highly effective in guiding personalised therapies
Subject(s)
Humans , Lung Neoplasms/diagnostic imaging , Positron Emission Tomography Computed Tomography/methods , Clinical Decision-Making , Fluorodeoxyglucose F18 , Lung Neoplasms/therapy , Neoplasm Metastasis , Neoplasm Recurrence, Local/diagnostic imaging , Neoplasm Staging , Positron Emission Tomography Computed Tomography/economics , Sensitivity and Specificity , Treatment Outcome , Combined Modality Therapy , Cost-Benefit Analysis , Diagnosis, Differential , Early DiagnosisABSTRACT
OBJECTIVE: Positron emission tomography/computed tomography (PET/CT) is an imaging technology that has experienced rapid development in recent years. The aim of this paper was to present the financial viability of a PET/CT department in a public hospital of Athens, Greece. This study performs a detailed financial analysis of the operating revenues and expenses of the department for the years 2007-2017. SUBJECTS AND METHODS: For each year considered, detailed analysis of incomes and expenses has been performed. During a normal working day 15 scans are acquired by the PET/CT department. Over the 11 years of operation, 22.035 scans had been performed in total. The turnover for the examined period reached 40.395.275 is this cumulative revenue over the 11 years. RESULTS: The following 6 evaluation and decision-making methods are presented: a) Net present value of the investment 2.245.251 (factor ß beta 0,6923), b) Internal rate of return was estimated 34,89%, c) The payback period is achieved by 2011, d) The profitability index is 2,10, e) Average rate of return or accounting rate of return is 27,20%, and f) Return On Investment is estimated 299,25%. CONCLUSION: Even if we have to consider that it is not proper to evaluate with financial terms health, it is concluded through the present study that the investment for settling and operating the under-examination PET/CT unit of the present public hospital was financially profitable.
Subject(s)
Costs and Cost Analysis , Hospitals, Public/economics , Positron Emission Tomography Computed Tomography/economics , Greece , HumansABSTRACT
OBJECTIVE: To investigate the correlation between the utilization of nuclear medicine diagnostic procedures and the mortality of women with breast cancer. SUBJECTS AND METHODS: Based on the National Health Insurance Research Database (NHIRD), we studied female breast cancer patients in 2012 who underwent whole-body bone scan, lymphoscintigraphy, or fluorine-18-fluorodeoxyglucose positron emission tomography/computed tomography (18F-FDG PET/CT) for possibly managing breast cancer metastases. The mortality of breast cancer was then followed up in 2017. Multiple linear regression analysis was applied to analyze the correlation between the use of any of these three nuclear medicine procedures and the mortality of breast cancer. RESULTS: For patients with early-stage breast cancer, single lymphoscintigraphy was the most frequently performed nuclear medicine procedure, accounting for 36.4% of all three nuclear medicine procedures. For patients with late-stage breast cancer, single whole-body bone scan was the most frequently performed nuclear medicine procedure, accounting for 67.2% of all three nuclear medicine procedures. Mortality of breast cancer significantly increased with the prevalence of late-stage breast cancer (b=2.87, P=0.001) and significantly decreased in cases in which whole-body bone scan was used (b=-4.28, P=0.003). CONCLUSION: The mortality of women with late-stage breast cancer was negatively related to the utilization of whole-body bone scan but not to the utilization of lymphoscintigraphy or the 18F-FDG PET/CT scan. In women with early-stage breast cancer, no significant correlation existed between breast cancer mortality and the utilization of the above three nuclear medicine procedures.
Subject(s)
Breast Neoplasms/diagnostic imaging , Breast Neoplasms/mortality , Databases, Factual , National Health Programs/statistics & numerical data , Nuclear Medicine/economics , Adolescent , Adult , Aged , Aged, 80 and over , Breast Neoplasms/pathology , Female , Fluorodeoxyglucose F18 , Humans , Middle Aged , Neoplasm Metastasis , Positron Emission Tomography Computed Tomography/economics , Taiwan , Young AdultABSTRACT
Lung cancer is a fairly common malignancy. An early diagnosis and a reliable staging and re-staging with the aim to detect both local and distant relapse are of utmost importance in planning the therapeutic management. The imaging diagnostic work-up of patients with lung cancer usually includes conventional imaging (chest X-ray, contrast-enhanced CT, bone scan) and more recently 18F-FDG PET/CT. Great advances in the management of lung cancer are based on the information provided by 18F-FDG PET/CT, as it supplies both metabolic and anatomic information (better localisation). There is vast evidence in the literature demonstrating its utility in (a) characterising benign versus malignant solitary nodules, (b) staging and re-staging lung cancer, (c) guiding the type of therapy, (d) monitoring treatment response and (e) predicting outcome. In particular, given its specificity in differentiating 18F-FDG-avid relapse from post-surgical changes or post-radiation fibrosis (which do not take up 18F-FDG), PET/CT can detect recurrent disease after initial treatment and (being a whole-body technique) has demonstrated high accuracy in the detection of distant metastases or secondary tumours. In conclusion, 18F-FDG PET/CT can be considered a highly accurate and reliable method for staging and re-staging lung cancer, and is highly effective in guiding personalised therapies.