OBJECTIVES: Most guidelines consider FDG PET-CT to detect occult extra-pulmonary disease prior to lung metastasectomy. A cost-effectiveness analysis, using a Markov model over a 10 year period, was performed to compare two different surveillance programs, either PET-CT or whole-body CT, in patients with suspected pulmonary metastasised melanoma. METHODS: Data from published studies provided probabilities for the model. Complication and care costs were obtained from standardised administrative databases from 19 hospitals identified by DRG codes (reported in 2009 Euros). For the cost calculation of PET-CT we performed a microcosting analysis. All costs and benefits were yearly discounted at respectively 3% and 1.5%. Outcomes included life-months gained (LMG) and the number of futile surgeries avoided. Cost-effectiveness ratios were in Euros per LMG. Univariate and probabilistic sensitivity analyses addressed uncertainty in all model parameters. RESULTS: The PET-CT strategy provided 86.29 LMG (95% CI: 81.50-90.88 LMG) at a discounted cost of euro3,974 (95% CI: euro1,339-12,303), while the conventional strategy provided 86.08 LMG (95% CI: 81.37-90.68 LMG) at a discounted cost of euro5,022 (95% CI: euro1,378-16,018). This PET-CT strategy resulted in a net saving of euro1,048 with a gain of 0.2 LMG. Based on PET-CT findings, 20% of futile surgeries could be avoided. CONCLUSION: Integrating PET-CT in the management of patients with high risk MM appears to be less costly and more accurate by avoiding futile thoracotomies in one of five patients as well as by providing a small survival benefit at 10 years.
OBJECTIVES: Most guidelines consider FDG PET-CT to detect occult extra-pulmonary disease prior to lung metastasectomy. A cost-effectiveness analysis, using a Markov model over a 10 year period, was performed to compare two different surveillance programs, either PET-CT or whole-body CT, in patients with suspected pulmonary metastasised melanoma. METHODS: Data from published studies provided probabilities for the model. Complication and care costs were obtained from standardised administrative databases from 19 hospitals identified by DRG codes (reported in 2009 Euros). For the cost calculation of PET-CT we performed a microcosting analysis. All costs and benefits were yearly discounted at respectively 3% and 1.5%. Outcomes included life-months gained (LMG) and the number of futile surgeries avoided. Cost-effectiveness ratios were in Euros per LMG. Univariate and probabilistic sensitivity analyses addressed uncertainty in all model parameters. RESULTS: The PET-CT strategy provided 86.29 LMG (95% CI: 81.50-90.88 LMG) at a discounted cost of euro3,974 (95% CI: euro1,339-12,303), while the conventional strategy provided 86.08 LMG (95% CI: 81.37-90.68 LMG) at a discounted cost of euro5,022 (95% CI: euro1,378-16,018). This PET-CT strategy resulted in a net saving of euro1,048 with a gain of 0.2 LMG. Based on PET-CT findings, 20% of futile surgeries could be avoided. CONCLUSION: Integrating PET-CT in the management of patients with high risk MM appears to be less costly and more accurate by avoiding futile thoracotomies in one of five patients as well as by providing a small survival benefit at 10 years.
Authors: Eric C Ehman; Geoffrey B Johnson; Javier E Villanueva-Meyer; Soonmee Cha; Andrew Palmera Leynes; Peder Eric Zufall Larson; Thomas A Hope Journal: J Magn Reson Imaging Date: 2017-03-30 Impact factor: 4.813
Authors: Thomas Pfluger; Henriette Ingrid Melzer; Vera Schneider; Christian La Fougere; Eva Coppenrath; Carola Berking; Peter Bartenstein; Mayo Weiss Journal: Eur J Nucl Med Mol Imaging Date: 2011-01-06 Impact factor: 9.236
Authors: Jacqueline Dinnes; Lavinia Ferrante di Ruffano; Yemisi Takwoingi; Seau Tak Cheung; Paul Nathan; Rubeta N Matin; Naomi Chuchu; Sue Ann Chan; Alana Durack; Susan E Bayliss; Abha Gulati; Lopa Patel; Clare Davenport; Kathie Godfrey; Manil Subesinghe; Zoe Traill; Jonathan J Deeks; Hywel C Williams Journal: Cochrane Database Syst Rev Date: 2019-07-01
Authors: Mbathio Dieng; Nikita Khanna; Mai Thi Hoang Nguyen; Robin Turner; Sarah J Lord; Alexander M Menzies; Jay Allen; Robyn Saw; Omgo E Nieweg; John Thompson; Rachael L Morton Journal: BMJ Open Date: 2020-11-05 Impact factor: 2.692