Use of a Decision Analysis Model to Assess the Cost-Effectiveness of 18F-FDG PET in the Management of Metachronous Liver Metastases of Colorectal Cancer

Journal of Nuclear Medicine

Thierry Conroy¹  Jean Faivre¹  Francis Guillemin¹  Pierre Bey¹  Catherine Zanni¹  Laurent Bedenne¹  Catherine Lejeune¹  Patrick Arveux¹  Marie J. Bismuth¹ 

关键词: PET;    metachromous metastases;    decision modeling;    cost-effectiveness;    program evaluation;   

DOI  :  

学科分类：医学（综合）

来源: Society of Nuclear Medicine

【 摘 要 】

Few data exist on the medicoeconomic usefulness of PET in the management of metachronous liver metastases from colorectal cancer. This study was designed to assess the cost-effectiveness of PET in the diagnosis and staging of patients with metachronous liver metastases of colorectal cancer using a decision analysis model. Methods: Two alternatives were compared: CT and CT associated with PET (CT + PET). Transition probabilities were estimated from published data and consultations with experts. Survival data were provided by the Burgundy Digestive Cancer Registry (France). Costs of imaging techniques and treatments were assessed using reimbursements from the French health care insurance for the year 2004. Evaluation criteria included incremental cost-effectiveness ratios and the proportion of unnecessary operations avoided in patients without metachronous liver metastases. Results: CT + PET was the most cost-effective strategy, presenting an expected incremental cost saving of 2,671 € (∼$3,213) per patient, for the same level of expected effectiveness as CT alone (1.88-y life expectancy per patient). Sensitivity analyses performed on epidemiologic and economic parameters showed that this model was robust. The model also suggested that CT + PET could avoid exploratory surgery for 6.1% of patientsthat is, 88.4% risk reduction compared with CT alone. Conclusion: PET for diagnosis and staging does not generate additional survival effectiveness compared with CT alone. However cost savings associated with its use and the improvement of therapeutic management therefore justify its generalization in clinical practice.

【 授权许可】

Unknown