Cost-effectiveness of FDG-PET for staging non-small cell lung cancer: A decision analysis

Background. Preliminary studies have shown that thoracic positron emission tomography (PET) is more accurate than thoracic computed tomography (CT) fo r the staging of non-small cell lung carcinoma. In the present study the co st-effectiveness, as measured by national Medicare reimbursed costs, and pa tient life expectancy are used to compare several thoracic PET-based strate gies with a conventional thoracic CT-based strategy for preoperative stagin g. Methods. Five decision strategies for selection of potential surgical candi dates were compared; thoracic CT alone or four different strategies that us e thoracic CT plus thoracic PET. The various paths of each strategy are dep endent on numerous variables that were determined from a review of the medi cal literature. Life expectancy was calculated using the declining exponent ial approximation of life expectancy and reduced on the basis of procedural morbidity and mortality. Costs were based on national Medicare reimbursed costs. For all possible outcomes of each strategy, the expected cost and pr ojected life expectancy were determined. The effects of changing one or mor e variables on the expected cost and life expectancy were studied using sen sitivity analysis. Results. A strategy that uses PET only after a negative CT study is shown t o be a cost-effective alternative to the CT-alone strategy ($25,286 per lif e-year saved). Conclusions. These results show through rigorous decision tree analysis the potential cost-effectiveness of using thoracic PET in the management of no n-small cell lung carcinoma. Greater use of thoracic PET for non-small cell lung carcinoma staging is warranted, and further clinical trials should he lp to validate the analytic results predicted from this study. (C) 1998 by The Society of Thoracic Surgeons.