COST-EFFECTIVENESS OF PET IMAGING IN CLINICAL ONCOLOGY

To be cost-effective, PET must be diagnostically accurate and effectiv e in improving management without increasing treatment cost. To evalua te 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 o f metastatic melanoma (36 patients), and staging of advanced head and neck cancer (29 patients). In each case, PET was more accurate than an atomic imaging for determination of the presence and extent of tumor a nd 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 reviewin g the treatment records of 72 patients with solitary pulmonary nodules or non-small-cell lung cancer, 68 patients with known or suspected re current colorectal cancer, 45 patients with known or suspected metasta tic melanoma, and 29 patients with advanced head and neck tumors. PET improved patient management by avoiding surgery for nonresectable tumo r and for CT abnormalities that proved to be benign by PET imaging. Fo r determining cost impact, the costs of surgical procedures were deter mined from Medicare reimbursement rates, and the cost of a PET study w as taken to be $1800. The savings from contraindicated surgical proced ures exceeded the cost of PET imaging by ratios of 2:1 to 4:1, dependi ng on the indication. PET was decisively more accurate and cost-effect ive than anatomic imaging by CT, combining improved patient care with reduced cost of management.