Decision analysis for the cost-effective management of recurrent colorectal cancer

Objective To determine whether the use of [18F]2-fluoro-2-deoxyglucose posi tron emission tomography (FDG PET) in addition to computed axial tomography (CT) is helpful in managing recurrent colorectal cancer (CRC). Summary Background Data There is no consensus on a management algorithm for CRC. However, when recurrence is suspected, CT is generally used for furth er evaluation and staging of disease. Methods The authors used decision trees based on theoretical models to asse ss the cost-effectiveness of a CT + FDG PET strategy for the diagnosis and management of recurrent CRC compared with a CT-alone strategy. These theore tical models focus on patients with hepatic recurrence who are potentially curable through surgical hepatic resection. The population entering the dec ision trees consisted of patients with CRC who had undergone surgical resec tion of their primary CRG and who were suspected of having recurrence based on elevated revels of carcinoembryonic antigen. Results The CT + FDG PET strategy was found to be cost-effective for managi ng patients with elevated carcinoembryonic antigen levels who were candidat es for hepatic resection. The CT + FDG PET strategy was higher in mean cost by $429 per patient but resulted in an increase in the mean life expectanc y of 9.527 days per patient. Conclusions These results show, through rigorous decision tree analysis, th e potential cost-effectiveness of FDG. PET in the management of recurrent C RC. The decision trees can be used to model various features of the managem ent of recurrent CRC, including the cost-effectiveness of other newly emerg ing technologies.