Studies of the Cost Effectiveness of PET in the Management of Patients with Colorectal Cancer
Reference
Valk et al. (1996)1
Country
USA
(Northern
California)
Year
Not provided
(on or before
1996)
Clinical Application
Diagnosis or staging of
recurrent colorectal cancer
Method
Retrospective chart review
(N=68). Cost savings resulting
from changes in treatment
modeled using Medicare
payment rates.
Comparators
PET vs. CT
Results
PET reduced
initial
treatment
costs
Valk et al. (1999)2
USA
(Northern
California)
Not provided
(on or before
1999)
Diagnosis or staging of
recurrent colorectal cancer
Prospective analysis of PETinduced changes in treatment.
Cost savings resulting from
changes in treatment modeled
using Medicare payment rates.
PET vs. CT
PET reduced
initial
treatment
costs
Lejeune et al.
(2005)3
France
2004
Diagnosis and staging of
suspected metachronous
liver metastases of
colorectal cancer
Lifetime cost-effectiveness
model
PET/CT vs. standard
of care (CT and MRI)
PET/CT had
lower costs
and similar
effectiveness
compared to
standard of
care (CT and
MRI)
Comments
- Did not examine impact on
patient outcomes.
- Did not account for costs
of additional surgeries
caused resulting from PET
- Assumed PET occurred
after CT (i.e., add-on)
- Did not examine impact on
patient outcomes.
- Did not account for costs of
additional surgeries caused
resulting from PET
- Used high PET costs
($1800); incorrectly ignored
PET costs for patients
unaffected by PET; assumed
PET occurred after CT (i.e.,
add-on)
- Full cost-effectiveness
analysis
- Includes comparison to
MRI
Reference List
(1) Valk PE, Pounds TR, Tesar RD, Hopkins DM, Haseman MK. Cost-effectiveness of PET imaging in clinical oncology. Nucl Med Biol.
1996;23:737-743.
Abstract: To be cost-effective, PET must be diagnostically accurate and effective in improving management without increasing treatment
cost. To evaluate diagnostic accuracy, we performed prospective evaluations of whole-body PET imaging in staging of non-small-cell lung
cancer (99 patients), detection of recurrent colorectal cancer (57 patients), diagnosis of metastatic melanoma (36 patients), and staging of
advanced head and neck cancer (29 patients). In each case, PET was more accurate than anatomic imaging for determination of the
presence and extent of tumor and demonstration of nonresectable disease. PET was also more accurate than conventional imaging in
staging Hodgkin's disease (30 patients). We evaluated the management impact of PET retrospectively, by reviewing the treatment records
of 72 patients with solitary pulmonary nodules or non-small-cell lung cancer, 68 patients with known or suspected recurrent colorectal
cancer, 45 patients with known or suspected metastatic melanoma, and 29 patients with advanced head and neck tumors. PET improved
patient management by avoiding surgery for nonresectable tumor and for CT abnormalities that proved to be benign by PET imaging. For
determining cost impact, the costs of surgical procedures were determined from Medicare reimbursement rates, and the cost of a PET
study was taken to be $1800. The savings from contraindicated surgical procedures exceeded the cost of PET imaging by ratios of 2:1 to
4:1, depending on the indication. PET was decisively more accurate and cost-effective than anatomic imaging by CT, combining improved
patient care with reduced cost of management
(2) Valk PE, bella-Columna E, Haseman MK et al. Whole-body PET imaging with [18F]fluorodeoxyglucose in management of recurrent
colorectal cancer. Arch Surg. 1999;134:503-511.
Abstract: HYPOTHESIS: Metabolic imaging by positron emission tomography (PET) using [18F]fluorodeoxyglucose will be more accurate
than anatomic imaging by computed tomography (CT) for detection of recurrent colorectal cancer. More accurate staging of recurrent
tumor by PET will lead to more appropriate management decisions. DESIGN: Prospective blinded study comparing PET with CT, using
histologic diagnosis, serial CT imaging, and clinical follow-up as criterion standards, with a fully blinded, retrospective reinterpretation of
PET studies. Changes in diagnosis resulting from PET findings were correlated with subsequent treatment and surgical findings. Potential
cost savings resulting from use of PET for preoperative staging were calculated. SETTING: Private practice in an outpatient tertiary referral
center. PATIENTS: A group of 155 consecutive patients with imaging for diagnosis or staging of recurrent colorectal cancer. Twenty-one
patient (14%) were excluded due to lack of a criterion standard. Computed tomographic scans were available for comparison for 115
patients. RESULTS: Positron emission tomographic scan sensitivity and specificity were 93% and 98%, respectively, compared with 69% and
96% for CT. Ninety-five percent confidence intervals for the differences between the modalities were 16% to 32% for sensitivity and 1% to
5% for specificity. The sensitivity of both modalities varied with anatomic site of recurrence. Positron emission tomographic scans were
true positive in 12 (67%) of 18 patients with elevated serum carcinoembryonic antigen levels and negative CT findings. In 23 (29%) of 78
preoperative studies in which CT showed a single site of recurrence, PET showed tumor at additional sites. At surgery, nonresectable, PETnegative tumor was found in 7 (17%) of 42 patients who had PET evidence of localized recurrence only. Potential savings resulting from
demonstration of nonresectable tumor by PET were calculated at $3003 per preoperative study. CONCLUSIONS: Positron emission
tomography was more sensitive and specific than CT for detection of recurrent colorectal cancer. Preoperative detection of nonresectable
tumor by PET may avoid unnecessary surgery, and thereby reduce the cost of patient treatment
(3) Lejeune C, Bismuth MJ, Conroy T et al. Use of a decision analysis model to assess the cost-effectiveness of 18F-FDG PET in the
management of metachronous liver metastases of colorectal cancer. J Nucl Med. 2005;46:2020-2028.
Abstract: Few data exist on the medicoeconomic usefulness of PET in the management of metachronous liver metastases from colorectal
cancer. This study was designed to assess the cost-effectiveness of PET in the diagnosis and staging of patients with metachronous liver
metastases of colorectal cancer using a decision analysis model. METHODS: Two alternatives were compared: CT and CT associated with
PET (CT+PET). Transition probabilities were estimated from published data and consultations with experts. Survival data were provided by
the Burgundy Digestive Cancer Registry (France). Costs of imaging techniques and treatments were assessed using reimbursements from
the French health care insurance for the year 2004. Evaluation criteria included incremental cost-effectiveness ratios and the proportion of
unnecessary operations avoided in patients without metachronous liver metastases. RESULTS: CT+PET was the most cost-effective
strategy, presenting an expected incremental cost saving of 2,671 (approximately $3,213) per patient, for the same level of expected
effectiveness as CT alone (1.88-y life expectancy per patient). Sensitivity analyses performed on epidemiologic and economic parameters
showed that this model was robust. The model also suggested that CT+PET could avoid exploratory surgery for 6.1% of patients-that is,
88.4% risk reduction compared with CT alone. CONCLUSION: PET for diagnosis and staging does not generate additional survival
effectiveness compared with CT alone. However cost savings associated with its use and the improvement of therapeutic management
therefore justify its generalization in clinical practice