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Research ArticleClinical Investigation

PET-Based Staging Is Cost-Effective in Early-Stage Follicular Lymphoma

Andrea C. Lo, Lyndon P. James, Anca Prica, Adam Raymakers, Stuart Peacock, Melody Qu, Alex V. Louie, Kerry J. Savage, Laurie H. Sehn, David Hodgson, Joanna C. Yang, Hans T.T. Eich, Andrew Wirth and M.G. Myriam Hunink
Journal of Nuclear Medicine April 2022, 63 (4) 543-548; DOI: https://doi.org/10.2967/jnumed.121.262324
Andrea C. Lo
1Department of Radiation Oncology, BC Cancer, University of British Columbia, Vancouver, British Columbia, Canada;
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Lyndon P. James
2PhD Program in Health Policy, Harvard University, Cambridge, Massachusetts;
3Center for Health Decision Science, Harvard T.H. Chan School of Public Health, Boston, Massachusetts;
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Anca Prica
4Department of Medical Oncology and Hematology, Princess Margaret Cancer Centre, Toronto, Ontario, Canada;
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Adam Raymakers
5Cancer Control Research, BC Cancer, Vancouver, British Columbia, Canada;
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Stuart Peacock
5Cancer Control Research, BC Cancer, Vancouver, British Columbia, Canada;
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Melody Qu
6Department of Radiation Oncology, London Health Sciences Centre, Western University, London, Ontario, Canada;
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Alex V. Louie
7Department of Radiation Oncology, Sunnybrook Health Sciences Centre, University of Toronto, Toronto, Ontario, Canada;
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Kerry J. Savage
8Centre for Lymphoid Cancer, Department of Medical Oncology, BC Cancer, Vancouver, British Columbia, Canada,
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Laurie H. Sehn
8Centre for Lymphoid Cancer, Department of Medical Oncology, BC Cancer, Vancouver, British Columbia, Canada,
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David Hodgson
9Radiation Medicine Program, Princess Margaret Cancer Centre, Toronto, Ontario, Canada;
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Joanna C. Yang
10Department of Radiation Oncology, University of California, San Francisco, San Francisco, California;
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Hans T.T. Eich
11Department of Radiation Oncology, University Hospital Muenster, Muenster, Germany;
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Andrew Wirth
12Department of Radiation Oncology, Peter MacCallum Cancer Centre, Melbourne, Australia; and
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M.G. Myriam Hunink
3Center for Health Decision Science, Harvard T.H. Chan School of Public Health, Boston, Massachusetts;
13Clinical Epidemiology and Radiology, Erasmus University, Rotterdam, Netherlands
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Abstract

The objective was to assess the cost-effectiveness of staging PET/CT in early-stage follicular lymphoma (FL) from the Canadian health-care system perspective. Methods: The study population was FL patients staged as early-stage using conventional CT imaging and planned for curative-intent radiation therapy (RT). A decision analytic model simulated the management after adding staging PET/CT versus using staging CT alone. In the no-PET/CT strategy, all patients proceeded to curative-intent RT as planned. In the PET/CT strategy, PET/CT information could result in an increased RT volume, switching to a noncurative approach, or no change in RT treatment as planned. The subsequent disease course was described using a state-transition cohort model over a 30-y time horizon. Diagnostic characteristics, probabilities, utilities, and costs were derived from the literature. Baseline analysis was performed using quality-adjusted life years (QALYs), costs (2019 Canadian dollars), and the incremental cost-effectiveness ratio. Deterministic sensitivity analyses were conducted, evaluating net monetary benefit at a willingness-to-pay threshold of $100,000/QALY. Probabilistic sensitivity analysis using 10,000 simulations was performed. Costs and QALYs were discounted at a rate of 1.5%. Results: In the reference case scenario, staging PET/CT was the dominant strategy, resulting in an average lifetime cost saving of $3,165 and a gain of 0.32 QALYs. In deterministic sensitivity analyses, the PET/CT strategy remained the preferred strategy for all scenarios supported by available data. In probabilistic sensitivity analysis, the PET/CT strategy was strongly dominant in 77% of simulations (i.e., reduced cost and increased QALYs) and was cost-effective in 89% of simulations (i.e., either saved costs or had an incremental cost-effectiveness ratio below $100,000/QALY). Conclusion: Our analysis showed that the use of PET/CT to stage early-stage FL patients reduces cost and improves QALYs. Patients with early-stage FL should undergo PET/CT before curative-intent RT.

  • PET/CT
  • follicular lymphoma
  • radiation therapy
  • cost-effectiveness analysis
  • staging

Footnotes

  • Published online August 19, 2021.

  • © 2022 by the Society of Nuclear Medicine and Molecular Imaging.
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Journal of Nuclear Medicine: 63 (4)
Journal of Nuclear Medicine
Vol. 63, Issue 4
April 1, 2022
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PET-Based Staging Is Cost-Effective in Early-Stage Follicular Lymphoma
Andrea C. Lo, Lyndon P. James, Anca Prica, Adam Raymakers, Stuart Peacock, Melody Qu, Alex V. Louie, Kerry J. Savage, Laurie H. Sehn, David Hodgson, Joanna C. Yang, Hans T.T. Eich, Andrew Wirth, M.G. Myriam Hunink
Journal of Nuclear Medicine Apr 2022, 63 (4) 543-548; DOI: 10.2967/jnumed.121.262324

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PET-Based Staging Is Cost-Effective in Early-Stage Follicular Lymphoma
Andrea C. Lo, Lyndon P. James, Anca Prica, Adam Raymakers, Stuart Peacock, Melody Qu, Alex V. Louie, Kerry J. Savage, Laurie H. Sehn, David Hodgson, Joanna C. Yang, Hans T.T. Eich, Andrew Wirth, M.G. Myriam Hunink
Journal of Nuclear Medicine Apr 2022, 63 (4) 543-548; DOI: 10.2967/jnumed.121.262324
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Keywords

  • PET/CT
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  • staging
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