The cost-effectiveness of fluorodeoxyglucose 18-F positron emission tomography in the NO neck

BACKGROUND. Although surgery and radiation are effective treatments of regi onal lymphatics for classification NO head and neck squamous cell carcinoma (HNSCC) patients, both have morbidities that could be avoided in approxima tely 70% of patients without lymph node disease with better diagnostic info rmation. 18-F fluoro-2-deoxyglucose positron emission tomography (FDG-PET) has shown promise in detecting subclinical lymph node disease, but its cost and availability have limited its use. Here, we sought to determine whethe r the use of FDG-PET was cost-effective as part of a treatment strategy for classification NO HNSCC patients. METHODS. The cost-effectiveness of proceeding from classification of NO by computed tomography to a PET scan was estimated using standard methods of e conomic evaluation. Costs were for a large, Midwestern university medical c enter. Probabilities were computed from a review of the literature. Utiliti es were obtained by a time-tradeoff method, and life expectancy was estimat ed using the Surveillance, Epidemiology, and End Results database. Outcomes measures were cost per year of life saved and cost per quality- adjusted l ife-year. RESULTS. Modified radical neck dissection was associated with the lowest mo rbidity (utility [u] = 0.93), and radical neck dissection plus radiation wa s associated with the highest (u = 0.68). Life expectancy was estimated to be 5.9 and 11.5 years for patients with and without lymph node disease, res pectively. The incremental cost- effectiveness ratio for the PET strategy w as $8718 per year of life saved, or $2 505 per quality- adjusted life-year. CONCLUSIONS. A diagnostic and treatment strategy that proceeds from classif ication of NO to a PET scan is cost-effective. Prospective studies that eva luate this strategy are important to assure that these simulation results a re realized in clinical practice. (C) 2001 American Cancer Society.