Cost Effectiveness of Positron Emission Tomography for the Management of Potentially Operable Non-Small Cell Lung Cancer in Quebec

Abstract

BACKGROUND: The potential benefits of positron emission tomography (PET) scanning stem from the fact that it can reduce the number of diagnostic examinations; particularly, the number of unnecessary thoracic surgeries.OBJECTIVE: To evaluate the economic impact and cost-effectiveness of PET scanning in the management of potentially operable non-small cell lung cancer in Quebec.METHODS: A decision tree was developed. Two strategies were compared: chest computed tomography (CT) alone or CT and whole-body PET. The various paths of each strategy were dependent on the numerous variables that were determined from a literature review. The costs and life expectancy were determined for each strategy under consideration. Life expectancy was calculated using the declining exponential approximation of life expectancy. Costs were obtained from the Quebec diagnosis-related group database and Quebec physician fee schedules.RESULTS: The mean cost of the CT strategy was $8,455 per patient compared with $9,723 for the PET strategy, for a cost differential of $1,268. The PET strategy extended life expectancy by slightly more than three months (0.27 years) compared with the survival of the CT strategy. The incremental cost-effectiveness ratio was $4,689. Considering the number of new cases and the prevalence of mediastinal metastases, the budget impact would be $8,613,693.CONCLUSION: The use of PET to detect local and distant metastases in non-small cell lung cancer is an intervention that would require an acceptable investment for each life-year gained.