18FDG-PET-CT in the follow-up of non-small cell lung cancer patients after radical radiotherapy with or without chemotherapy: An economic evaluation
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.
aDepartment of Radiation Oncology (Maastro Clinic), GROW Research Institute, Maastricht University Medical Centre+, Maastricht, The Netherlands
bDepartment of Nuclear Medicine, Maastricht University Medical Centre+, Maastricht, The Netherlands
cDepartment of Radiology, Maastricht University Medical Centre+, Maastricht, The Netherlands
dDepartment of Pulmonology, Maastricht University Medical Centre+, Maastricht, The Netherlands
eDepartment of Pulmonology, Atrium Medical Centre, Heerlen, The Netherlands
fDepartment of Pulmonology, Orbis Medical Centre, Sittard, The Netherlands
gDepartment of Pulmonology, Laurentius Hospital, Roermond, The Netherlands
hDepartment of Pulmonology, St. Jans Hospital, Weert, The Netherlands
iDepartment of Health Organization, Policy and Economics, CAPHRI 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.
ABSTRACT