Decision-tree sensitivity analysis for cost-effectiveness of chest 2-Fluoro-2-D-[F-18]Fluorodeoxyglucose positron emission tomography in patients with pulmonary nodules (non-small cell lung carcinoma) in Japan

Context: Recent studies have demonstrated the potential cost-effectiveness of using 2-fluoro-2-D-[F-18]fluorodeoxyglucose (FDG) positron emission tomo graphy (PET) in the management of non-small cell lung carcinoma (NSCLC), hu t because of differences in health-care systems, those findings may not hol d true in a Japanese hospital. Objective: To assess the cost-effectiveness of the chest CT plus chest FDG- PET strategy in Japan. Design: Decision-tree sensitivity analysis based on the two competing strat egies of chest CT-alone vs chest CT plus chest FDG-PET, Study selection: A simulation of 1,000 patients in whom NSCLC, stage IIIB o r less, was suspected was created using baselines of other relevant variabl es in regard to sensitivity, specificity, mortality, life expectancy, and c ost from published data, Methods: We surveyed the relevant literature for the choice of variables. Main outcome measures: Expected marginal cost and expected life expectancy gain for NSCLC patients. Results: The chest CT plus chest FDG-PET strategy yielded an expected life expectancy gain of 0.607 years (7.3 months) per patient, compared with the alternative strategy of chest CT-alone, Using an FDG-PET examination cost o f 1.0 x 10(5) yen (around $700 US) per study, the cost increment was 2.18 x 10(5) yen/yr/patient. Conclusions: The chest CT plus chest FDG-PET strategy in patients with NSCL C is unlikely to be cost-effective in Japan. However, patient life expectan cy gain would increase as a result of improved staging of NSCLC. These prel iminary results should be confirmed by further studies for specific environ ments.