¹⁸FDG-PET-CT in the follow-up of non-small cell lung cancer patients after radical radiotherapy with or without chemotherapy: An economic evaluation

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• 作者：Judith van Loon ; Janneke P.C. Grutters ; Rinus W ; ers ; Liesbeth Boersma ; Anne-Marie C. Dingemans ; Gerben Bootsma ; Wiel Geraedts ; Cordula Pitz ; Jean Simons ; Boudewijn Brans ; Gabriel Snoep ; Monique Hochst
• 关键词：Cost-effectiveness ; Follow-up ; Non-small cell lung cancer ; PET
• 刊名：European Journal of Cancer
• 出版年：2010
• 出版时间：January 2010
• 年：2010
• 卷：46
• 期：1
• 页码：110-119
• 全文大小：272 K

文摘

Background

The optimal follow-up strategy of non-small cell lung cancer (NSCLC) patients after curative intent therapy is still not established. In a recent prospective study with 100 patients, we showed that a FDG-PET-CT 3 months after radiotherapy (RT) could identify progression amenable for curative treatment in 2 % (95 % confidence interval (CI): 1–7 % ) of patients, who were all asymptomatic. Here, we report on the economic evaluation of this study.

Patients and methods

A decision-analytic Markov model was developed in which the long-term cost-effectiveness of 3 follow-up strategies was modelled with different imaging methods 3 months after therapy: a PET-CT scan; a chest CT scan; and conventional follow-up with a chest X-ray. A probabilistic sensitivity analysis was performed to account for uncertainty. Because the results of the prospective study indicated that the advantage seems to be confined to asymptomatic patients, we additionally examined a strategy where a PET-CT was applied only in the subgroup of asymptomatic patients. Cost-effectiveness of the different follow-up strategies was expressed in incremental cost-effectiveness ratios (ICERs), calculating the incremental costs per quality adjusted life year (QALY) gained.

Results

Both PET-CT- and CT-based follow-up were more costly but also more effective than conventional follow-up. CT-based follow-up was only slightly more effective than conventional follow-up, resulting in an incremental cost-effectiveness ratio (ICER) of € 264.033 per QALY gained. For PET-CT-based follow-up, the ICER was € 69.086 per QALY gained compared to conventional follow-up. The strategy in which a PET-CT was only performed in the asymptomatic subgroup resulted in an ICER of € 42.265 per QALY gained as opposed to conventional follow-up. With this strategy, given a ceiling ratio of € 80.000, PET-CT-based follow-up had the highest probability of being cost-effective (73 % ).

Conclusions

This economic evaluation shows that a PET-CT scan 3 months after (chemo)radiotherapy with curative intent is a potentially cost-effective follow-up method, and is more cost-effective than CT alone. Applying a PET-CT scan only in asymptomatic patients is probably as effective and more cost-effective. It is worthwhile to perform additional research to reduce uncertainty regarding the decision concerning imaging in the follow-up of NSCLC.