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

van Loon, Judith; Grutters, Janneke P.C.; Wanders, Rinus; Boersma, Liesbeth; Dingemans, Anne-Marie C.; Bootsma, Gerben; Geraedts, Wiel; Pitz, Cordula; Simons, Jean; Brans, Boudewijn; Snoep, Gabriel; Hochstenbag, Monique; Lambin, Philippe; De Ruysscher, Dirk

doi:10.1016/j.ejca.2009.10.028

« Previous Next »European Journal of Cancer
Volume 46, Issue 1 , Pages 110-119, January 2010

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

Judith van Loon
- Department of Radiation Oncology (Maastro Clinic), GROW Research Institute, Maastricht University Medical Centre⁺, Maastricht, The Netherlands
- Corresponding author: Address: MAASTRO Clinic, Dr. Tanslaan 12, NL-6229 ET Maastricht, The Netherlands. Tel.: +31 88 4455666; fax: +31 88 4455667.
Janneke P.C. Grutters
- Department of Radiation Oncology (Maastro Clinic), GROW Research Institute, Maastricht University Medical Centre⁺, Maastricht, The Netherlands
- Department of Health Organization, Policy and Economics, CAPHRI Research Institute, Maastricht University Medical Centre⁺, Maastricht, The Netherlands
Rinus Wanders
- Department of Radiation Oncology (Maastro Clinic), GROW Research Institute, Maastricht University Medical Centre⁺, Maastricht, The Netherlands
Liesbeth Boersma
- Department of Radiation Oncology (Maastro Clinic), GROW Research Institute, Maastricht University Medical Centre⁺, Maastricht, The Netherlands
Anne-Marie C. Dingemans
- Department of Pulmonology, Maastricht University Medical Centre⁺, Maastricht, The Netherlands
Gerben Bootsma
- Department of Pulmonology, Atrium Medical Centre, Heerlen, The Netherlands
Wiel Geraedts
- Department of Pulmonology, Orbis Medical Centre, Sittard, The Netherlands
Cordula Pitz
- Department of Pulmonology, Laurentius Hospital, Roermond, The Netherlands
Jean Simons
- Department of Pulmonology, St. Jans Hospital, Weert, The Netherlands
Boudewijn Brans
- Department of Nuclear Medicine, Maastricht University Medical Centre⁺, Maastricht, The Netherlands
Gabriel Snoep
- Department of Radiology, Maastricht University Medical Centre⁺, Maastricht, The Netherlands
Monique Hochstenbag
- Department of Pulmonology, Maastricht University Medical Centre⁺, Maastricht, The Netherlands
Philippe Lambin
- Department of Radiation Oncology (Maastro Clinic), GROW Research Institute, Maastricht University Medical Centre⁺, Maastricht, The Netherlands
Dirk De Ruysscher
- Department of Radiation Oncology (Maastro Clinic), GROW Research Institute, Maastricht University Medical Centre⁺, Maastricht, The Netherlands

Received 12 October 2009; accepted 29 October 2009. published online 30 November 2009.

Abstract

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.

Keywords: Cost-effectiveness, Follow-up, Non-small cell lung cancer, PET