Author:
de Jongh Cas,van der Meulen Miriam P.,Gertsen Emma C.,Brenkman Hylke J. F.,van Sandick Johanna W.,van Berge Henegouwen Mark I.,Gisbertz Suzanne S.,Luyer Misha D. P.,Nieuwenhuijzen Grard A. P.,van Lanschot Jan J. B.,Lagarde Sjoerd M.,Wijnhoven Bas P. L.,de Steur Wobbe O.,Hartgrink Henk H.,Stoot Jan H. M. B.,Hulsewe Karel W. E.,Spillenaar Bilgen Ernst Jan,van Det Marc J.,Kouwenhoven Ewout A.,Daams Freek,van der Peet Donald L.,van Grieken Nicole C. T.,Heisterkamp Joos,van Etten Boudewijn,van den Berg Jan-Willem,Pierie Jean-Pierre,Eker Hasan H.,Thijssen Annemieke Y.,Belt Eric J. T.,van Duijvendijk Peter,Wassenaar Eelco,Wevers Kevin P.,Hol Lieke,Wessels Frank J.,Haj Mohammad Nadia,Frederix Geert W. J.,van Hillegersberg Richard,Siersema Peter D.,Vegt Erik,Ruurda Jelle P.,
Abstract
Abstract
Background
Unnecessary D2-gastrectomy and associated costs can be prevented after detecting non-curable gastric cancer, but impact of staging on treatment costs is unclear. This study determined the cost impact of 18F-fluorodeoxyglucose positron emission tomography/computed tomography (18FFDG-PET/CT) and staging laparoscopy (SL) in gastric cancer staging.
Materials and Methods
In this cost analysis, four staging strategies were modeled in a decision tree: (1) 18FFDG-PET/CT first, then SL, (2) SL only, (3) 18FFDG-PET/CT only, and (4) neither SL nor 18FFDG-PET/CT. Costs were assessed on the basis of the prospective PLASTIC-study, which evaluated adding 18FFDG-PET/CT and SL to staging advanced gastric cancer (cT3–4 and/or cN+) in 18 Dutch hospitals. The Dutch Healthcare Authority provided 18FFDG-PET/CT unit costs. SL unit costs were calculated bottom-up. Gastrectomy-associated costs were collected with hospital claim data until 30 days postoperatively. Uncertainty was assessed in a probabilistic sensitivity analysis (1000 iterations).
Results
18FFDG-PET/CT costs were €1104 including biopsy/cytology. Bottom-up calculations totaled €1537 per SL. D2-gastrectomy costs were €19,308. Total costs per patient were €18,137 for strategy 1, €17,079 for strategy 2, and €19,805 for strategy 3. If all patients undergo gastrectomy, total costs were €18,959 per patient (strategy 4). Performing SL only reduced costs by €1880 per patient. Adding 18FFDG-PET/CT to SL increased costs by €1058 per patient; IQR €870–1253 in the sensitivity analysis.
Conclusions
For advanced gastric cancer, performing SL resulted in substantial cost savings by reducing unnecessary gastrectomies. In contrast, routine 18FFDG-PET/CT increased costs without substantially reducing unnecessary gastrectomies, and is not recommended due to limited impact with major costs.
Trial registration: NCT03208621. This trial was registered prospectively on 30-06-2017.
Publisher
Springer Science and Business Media LLC