PURPOSE: (18)F-fluorodeoxyglucose positron emission tomography (FDG-PET) imaging is an important staging procedure in patients with non-small cell lung cancer (NSCLC). We aimed to demonstrate, through a decision tree model and the incorporation of real costs of each component, that routine FDG-PET imaging as a prelude to curative surgery will reduce requirements for routine mediastinoscopy and overall hospital costs. METHODS: A decision tree model comparing routine whole-body FDG-PET imaging to routine staging mediastinoscopy was used, with baseline variables of sensitivity, specificity and prevalence of non-operable and metastatic disease obtained from institutional data and a literature review. Costings for hospital admissions for mediastinoscopy and thoracotomy of actual patients with NSCLC were determined. The overall and average cost of managing patients was then calculated over a range of FDG-PET costs to derive projected cost savings to the community. RESULTS: The prevalence of histologically proven mediastinal involvement in patients with NSCLC presenting for surgical assessment at our institution is 20%, and the prevalence of distant metastatic disease is 6%. Based on literature review, the pooled sensitivity and specificity of FDG-PET for detection of mediastinal spread are 84% and 89% respectively, and for mediastinoscopy, 81% and 100%. The average cost of mediastinoscopy for NSCLC in our institution is 4,160 AUD, while that of thoracotomy is 15,642 AUD. The cost of an FDG-PET scan is estimated to be 1,500 AUD. Using these figures and the decision tree model, the average cost saving is 2,128 AUDper patient. CONCLUSION: Routine FDG-PET scanning with selective mediastinoscopy will save 2,128 AUD per patient and will potentially reduce inappropriate surgery. These cost savings remain robust over a wide range of disease prevalence and FDG-PET costs.
PURPOSE: (18)F-fluorodeoxyglucose positron emission tomography (FDG-PET) imaging is an important staging procedure in patients with non-small cell lung cancer (NSCLC). We aimed to demonstrate, through a decision tree model and the incorporation of real costs of each component, that routine FDG-PET imaging as a prelude to curative surgery will reduce requirements for routine mediastinoscopy and overall hospital costs. METHODS: A decision tree model comparing routine whole-body FDG-PET imaging to routine staging mediastinoscopy was used, with baseline variables of sensitivity, specificity and prevalence of non-operable and metastatic disease obtained from institutional data and a literature review. Costings for hospital admissions for mediastinoscopy and thoracotomy of actual patients with NSCLC were determined. The overall and average cost of managing patients was then calculated over a range of FDG-PET costs to derive projected cost savings to the community. RESULTS: The prevalence of histologically proven mediastinal involvement in patients with NSCLC presenting for surgical assessment at our institution is 20%, and the prevalence of distant metastatic disease is 6%. Based on literature review, the pooled sensitivity and specificity of FDG-PET for detection of mediastinal spread are 84% and 89% respectively, and for mediastinoscopy, 81% and 100%. The average cost of mediastinoscopy for NSCLC in our institution is 4,160 AUD, while that of thoracotomy is 15,642 AUD. The cost of an FDG-PET scan is estimated to be 1,500 AUD. Using these figures and the decision tree model, the average cost saving is 2,128 AUDper patient. CONCLUSION: Routine FDG-PET scanning with selective mediastinoscopy will save 2,128 AUD per patient and will potentially reduce inappropriate surgery. These cost savings remain robust over a wide range of disease prevalence and FDG-PET costs.
Authors: V Kalff; R J Hicks; M P MacManus; D S Binns; A F McKenzie; R E Ware; A Hogg; D L Ball Journal: J Clin Oncol Date: 2001-01-01 Impact factor: 44.544
Authors: R M Pieterman; J W van Putten; J J Meuzelaar; E L Mooyaart; W Vaalburg; G H Koëter; V Fidler; J Pruim; H J Groen Journal: N Engl J Med Date: 2000-07-27 Impact factor: 91.245
Authors: Harm van Tinteren; Otto S Hoekstra; Egbert F Smit; Jan H A M van den Bergh; Ad J M Schreurs; Roland A L M Stallaert; Piet C M van Velthoven; Emile F I Comans; Fred W Diepenhorst; Paul Verboom; Johan C van Mourik; Pieter E Postmus; Maarten Boers; Gerrit J J Teule Journal: Lancet Date: 2002-04-20 Impact factor: 79.321
Authors: Rosalie C Viney; Michael J Boyer; Madeleine T King; Patricia M Kenny; Christine A Pollicino; Jocelyn M McLean; Brian C McCaughan; Michael J Fulham Journal: J Clin Oncol Date: 2004-06-15 Impact factor: 44.544
Authors: Paul Verboom; Harm van Tinteren; Otto S Hoekstra; Egbert F Smit; Jan H A M van den Bergh; Ad J M Schreurs; Roland A L M Stallaert; Piet C M van Velthoven; Emile F I Comans; Fred W Diepenhorst; Johan C van Mourik; Pieter E Postmus; Maarten Boers; Els W M Grijseels; Gerrit J J Teule; Carin A Uyl-de Groot Journal: Eur J Nucl Med Mol Imaging Date: 2003-05-29 Impact factor: 9.236
Authors: Didier Lardinois; Walter Weder; Thomas F Hany; Ehab M Kamel; Stephan Korom; Burkhardt Seifert; Gustav K von Schulthess; Hans C Steinert Journal: N Engl J Med Date: 2003-06-19 Impact factor: 91.245