| HOME | HELP | FEEDBACK | SUBSCRIPTIONS | ARCHIVE | SEARCH | TABLE OF CONTENTS |
|
|
|
|||||||
|
|||||||||
The Crump Institute for Biological Imaging, Division of Nuclear Medicine, Department of Molecular and Medical Pharmacology, and Department of Biomathematics, UCLA School of Medicine, Los Angeles, California
Correspondence: For correspondence or reprints contact: Sanjiv Sam Gambhir, MD, PhD, Crump Institute for Biological Imaging, UCLA School of Medicine, A-222B JLNRC, 700 Westwood Plaza, Box 951770, Los Angeles, CA 90095-1770.
ABSTRACT
Preliminary studies have shown that PET is more accurate than CT for the staging of non-small-cell lung carcinoma (NSCLC). However, the potential effect of PET on the management of these patients and its cost-effectiveness has not been rigorously studied. Thus, we have used decision tree sensitivity analysis to assess the cost-effectiveness of a PET based strategy for staging of NSCLC. Methods: Two decision strategies for selection of potential surgical candidates were compared; thoracic CT alone or thoracic CT and thoracic PET. The first decision tree was conservatively constructed by requiring mediastinoscopy (biopsy) to confirm imaging results so that no patient with surgically curable disease would miss the opportunity for surgery in either strategy. A second less conservative tree in which only nonconcordant results are biopsied was also tested. The various paths of each strategy are dependent on numerous parameters which were determined from a review of the medical literature. Life expectancy was calculated using the declining exponential approximation of life expectancy and reduced based on procedural mortality. Costs were based on mean costs at our institution. For all possible outcomes of each strategy, the expected cost and projected life expectancy were determined. The effect of changing one or more parameters on the expected cost and life expectancy were studied using a sensitivity analysis. Results: The CT + PET strategy in the conservative decision tree showed a saving of $1154 per patient without a loss of life expectancy (increase of 2.96 days) as compared to the alternate strategy of CT alone. Both these effects were the result of improved staging of lung carcinoma prior to the decision for surgery. The CT + PET strategy in the less conservative decision tree showed a savings of $2267 per patient but misses 1.7% of potentially operable patients. Conclusion: These results show through rigorous decision tree analysis, the potential cost-effectiveness of using FDG PET in the management of NSCLC. These results form a basis for detailed study of the results obtained from multicenter trials on the accuracy of PET in NSCLC management. Further more, the techniques utilized for decision tree analysis have broad range of applicability to the entire field of nuclear medicine.
Key Words: PET • non-small-cell lung carcinoma • decision analysis • sensitivity analysis • cost-effectiveness
This article has been cited by other articles:
|
|
 |
|
  T. Bunyaviroch and R. E. Coleman PET Evaluation of Lung Cancer J. Nucl. Med., March 1, 2006; 47(3): 451 - 469. [Full Text] [PDF]
|
|
|
|
 |
|
 S. Sachs and T. V. Bilfinger The Impact of Positron Emission Tomography on Clinical Decision Making in a University-Based Multidisciplinary Lung Cancer Practice Chest, August 1, 2005; 128(2): 698 - 703. [Abstract] [Full Text] [PDF]
|
|
|
|
 |
|
 L. K. Shankar and D. C. Sullivan Functional Imaging in Lung Cancer J. Clin. Oncol., May 10, 2005; 23(14): 3203 - 3211. [Abstract] [Full Text] [PDF]
|
|
|
|
 |
|
 O. Birim, A. P. Kappetein, T. Stijnen, and A. J.J.C. Bogers Meta-Analysis of Positron Emission Tomographic and Computed Tomographic Imaging in Detecting Mediastinal Lymph Node Metastases in Nonsmall Cell Lung Cancer Ann. Thorac. Surg., January 1, 2005; 79(1): 375 - 382. [Abstract] [Full Text] [PDF]
|
|
|
|
 |
|
 C. C. Earle Outcomes Research in Lung Cancer J Natl Cancer Inst Monographs, October 1, 2004; 2004(33): 56 - 77. [Abstract] [Full Text] [PDF]
|
|
|
|
 |
|
 K. Pacak, G. Eisenhofer, and D. S. Goldstein Functional Imaging of Endocrine Tumors: Role of Positron Emission Tomography Endocr. Rev., August 1, 2004; 25(4): 568 - 580. [Abstract] [Full Text] [PDF]
|
|
|
|
|
|
P. S. Oturai, J. Mortensen, H. Enevoldsen, A. Eigtved, V. Backer, K. P. Olesen, H. W. Nielsen, H. Hansen, P. Stentoft, and L. Friberg {gamma}-Camera 18F-FDG PET in Diagnosis and Staging of Patients Presenting with Suspected Lung Cancer and Comparison with Dedicated PET J. Nucl. Med., August 1, 2004; 45(8): 1351 - 1357. [Abstract] [Full Text] [PDF]
|
|
|
|
|
|
F. C. Detterbeck, S. Falen, M. P. Rivera, J. S. Halle, and M. A. Socinski Seeking a Home for a PET, Part 2: Defining the Appropriate Place for Positron Emission Tomography Imaging in the Staging of Patients With Suspected Lung Cancer Chest, June 1, 2004; 125(6): 2300 - 2308. [Abstract] [Full Text] [PDF]
|
|
|
|
|
|
D. G. Pfister, D. H. Johnson, C. G. Azzoli, W. Sause, T. J. Smith, S. Baker Jr, J. Olak, D. Stover, J. R. Strawn, A. T. Turrisi, et al. American Society of Clinical Oncology Treatment of Unresectable Non-Small-Cell Lung Cancer Guideline: Update 2003 J. Clin. Oncol., January 15, 2004; 22(2): 330 - 353. [Full Text] [PDF]
|
|
|
|
|
|
N. S. Majhail, J.-L. Urbain, J. M. Albani, M. H. Kanvinde, T. W. Rice, A. C. Novick, T. M. Mekhail, T. E. Olencki, P. Elson, and R. M. Bukowski F-18 Fluorodeoxyglucose Positron Emission Tomography in the Evaluation of Distant Metastases From Renal Cell Carcinoma J. Clin. Oncol., November 1, 2003; 21(21): 3995 - 4000. [Abstract] [Full Text] [PDF]
|
|
|
|
 |
|
 N Khan, N Oriuchi, T Higuchi, H Zhang, and K Endo PET in the follow-up of differentiated thyroid cancer Br. J. Radiol., October 1, 2003; 76(910): 690 - 695. [Abstract] [Full Text] [PDF]
|
|
|
|
|
|
O. Schillaci, A. Spanu, F. Scopinaro, F. Monteleone, M. E. Solinas, P. Volpino, P. Pirina, P. Marongiu, V. Cangemi, and G. Madeddu Mediastinal Lymph Node Involvement in Non-Small Cell Lung Cancer: Evaluation with 99mTc-Tetrofosmin SPECT and Comparison with CT J. Nucl. Med., August 1, 2003; 44(8): 1219 - 1224. [Abstract] [Full Text] [PDF]
|
|
|
|
 |
|
 M. Berger, M. K. Gould, and P. G. Barnett The Cost of Positron Emission Tomography in Six United States Veterans Affairs Hospitals and Two Academic Medical Centers Am. J. Roentgenol., August 1, 2003; 181(2): 359 - 365. [Abstract] [Full Text] [PDF]
|
|
|
|
|
|
J. P.A. Ioannidis and J. Lau 18F-FDG PET for the Diagnosis and Grading of Soft-Tissue Sarcoma: A Meta-Analysis J. Nucl. Med., May 1, 2003; 44(5): 717 - 724. [Abstract] [Full Text] [PDF]
|
|
|
|
|
|
G. R. Laking, P. M. Price, and B. O. Helal Clinical Impact of 18F-FDG PET in Thyroid Carcinoma Patients with Elevated Thyroglobulin Levels and Negative 131I Scanning Results After Therapy J. Nucl. Med., December 1, 2002; 43(12): 1728 - 1729. [Full Text]
|
|
|
|
|
|
M. A. Seltzer, C. S. Yap, D. H. Silverman, J. Meta, C. Schiepers, M. E. Phelps, S. S. Gambhir, J. Rao, P. E. Valk, and J. Czernin The Impact of PET on the Management of Lung Cancer: The Referring Physician's Perspective J. Nucl. Med., June 1, 2002; 43(6): 752 - 756. [Abstract] [Full Text] [PDF]
|
|
|
|
 |
|
 E. Salminen and M. Mac Manus FDG-PET imaging in the management of non-small-cell lung cancer Ann. Onc., March 1, 2002; 13(3): 357 - 360. [Abstract] [Full Text] [PDF]
|
|
|
|
 |
|
 R. Komaki, M. H. Chasen, W. D. Travis, J. B. Putnam, F. V. Fossella, R. W. Byhardt, and J. Y. Ro Oncodiagnosis Panel: 1999: Cancer of the Lung: Oncodiagnosis RadioGraphics, November 1, 2001; 21(6): 1573 - 1596. [Full Text] [PDF]
|
|
|
|
 |
|
 A.J. Poncelet, M. Lonneux, E. Coche, B. Weynand, and Ph. Noirhomme PET-FDG scan enhances but does not replace preoperative surgical staging in non-small cell lung carcinoma Eur. J. Cardiothorac. Surg., September 1, 2001; 20(3): 468 - 475. [Abstract] [Full Text] [PDF]
|
|
|
|
 |
|
 S F Barrington Whole body applications of positron emission tomography in oncology Imaging, September 1, 2001; 13(3): 185 - 196. [Abstract] [Full Text] [PDF]
|
|
|
|
 |
|
 G Laking and P Price 18-Fluorodeoxyglucose positron emission tomography (FDG-PET) and the staging of early lung cancer Thorax, September 1, 2001; 56(90002): ii38 - 44. [Full Text] [PDF]
|
|
|
|
|
|
R. Tucker, M. Coel, J. Ko, P. Morris, G. Druger, and P. McGuigan Impact of Fluorine-18 Fluorodeoxyglucose Positron Emission Tomography on Patient Management: First Year's Experience in a Clinical Center J. Clin. Oncol., May 1, 2001; 19(9): 2504 - 2508. [Abstract] [Full Text] [PDF]
|
|
|
|
 |
|
 J.F. Vansteenkiste and S.G. Stroobants The role of positron emission tomography with 18F-fluoro-2-deoxy-D-glucose in respiratory oncology Eur. Respir. J., April 1, 2001; 17(4): 802 - 820. [Abstract] [Full Text] [PDF]
|
|
|
|
|
|
J. Meta, M. Seltzer, C. Schiepers, D. H. Silverman, M. Ariannejad, S. S. Gambhir, M. E. Phelps, P. Valk, and J. Czernin Impact of 18F-FDG PET on Managing Patients with Colorectal Cancer: The Referring Physician's Perspective J. Nucl. Med., April 1, 2001; 42(4): 586 - 590. [Abstract] [Full Text]
|
|
|
|
 |
|
 D. OST and A. FEIN Evaluation and Management of the Solitary Pulmonary Nodule Am. J. Respir. Crit. Care Med., September 1, 2000; 162(3): 782 - 787. [Full Text]
|
|
|
|
 |
|
 S. U. Berlangieri and A. M. Scott Metabolic Staging of Lung Cancer N. Engl. J. Med., July 27, 2000; 343(4): 290 - 292. [Full Text]
|
|
|
|
|
|
A. Carretta, C. Landoni, G. Melloni, G. L. Ceresoli, A. Compierchio, F. Fazio, and P. Zannini 18-FDG positron emission tomography in the evaluation of malignant pleural diseases - a pilot study Eur. J. Cardiothorac. Surg., April 1, 2000; 17(4): 377 - 383. [Abstract] [Full Text] [PDF]
|
|
|
|
|
|
E. F. Patz Jr Imaging Bronchogenic Carcinoma Chest, April 1, 2000; 117(4_suppl_1): 90S - 95S. [Abstract] [Full Text] [PDF]
|
|
|
|
|
|
S. Kosuda, K. Ichihara, M. Watanabe, H. Kobayashi, and S. Kusano Decision-Tree Sensitivity Analysis for Cost-Effectiveness of Chest 2-Fluoro-2-D-[18F]Fluorodeoxyglucose Positron Emission Tomography in Patients With Pulmonary Nodules (Non-small Cell Lung Carcinoma) in Japan Chest, February 1, 2000; 117(2): 346 - 353. [Abstract] [Full Text] [PDF]
|
|
|
|
|
|
K. Shaffer Role of Radiology for Imaging and Biopsy of Solitary Pulmonary Nodules* Chest, December 1, 1999; 116(suppl_3): 519S - 522S. [Abstract] [Full Text] [PDF]
|
|
|
|
|
|
D. D. Maki, W. B. Gefter, and A. Alavi Recent Advances in Pulmonary Imaging Chest, November 1, 1999; 116(5): 1388 - 1402. [Abstract] [Full Text] [PDF]
|
|
|
|
 |
|
 E. M. Marom, H. P. McAdams, J. J. Erasmus, P. C. Goodman, D. K. Culhane, R. E. Coleman, J. E. Herndon, and E. F. Patz Jr Staging Non-Small Cell Lung Cancer with Whole-Body PET Radiology, September 1, 1999; 212(3): 803 - 809. [Abstract] [Full Text]
|
|
|
|
|
|
C. A.B. Saunders, J. E. Dussek, M. J. O'Doherty, and M. N. Maisey Evaluation of fluorine-18-fluorodeoxyglucose whole body positron emission tomography imaging in the staging of lung cancer Ann. Thorac. Surg., March 1, 1999; 67(3): 790 - 797. [Abstract] [Full Text] [PDF]
|
|
|
|
|
|
W. J. Scott, J. Shepherd, and S. S. Gambhir Cost-effectiveness of FDG-PET for staging non-small cell lung cancer: a decision analysis Ann. Thorac. Surg., December 1, 1998; 66(6): 1876 - 1883. [Abstract] [Full Text] [PDF]
|
|
|
|
|
|
V. J. Lowe and K. S. Naunheim Positron Emission Tomography in Lung Cancer Ann. Thorac. Surg., June 1, 1998; 65(6): 1821 - 1829. [Abstract] [Full Text] [PDF]
|
|
|
|
 |
|
 D. Delbeke, W. H. Martin, M. P. Sandler, W. C. Chapman, J. K. Wright Jr, and C. W. Pinson Evaluation of Benign vs Malignant Hepatic Lesions With Positron Emission Tomography Arch Surg, May 1, 1998; 133(5): 510 - 516. [Abstract] [Full Text] [PDF]
|
|
| HOME | HELP | FEEDBACK | SUBSCRIPTIONS | ARCHIVE | SEARCH | TABLE OF CONTENTS |
| JOURNAL OF NUCLEAR MEDICINE TECHNOLOGY | THE JOURNAL OF NUCLEAR MEDICINE |
