UNIVERSITY OF
TECHNOLOGY SYDNEY
Abstract
Background: There are several perceived benefits from introducing positron emission
tomography (PET) scanning into the staging of non small lung cancer (NSCLC).
However, its greatest primary benefit is the role it can potential perform in reducing the
number of unnecessary diagnostic examinations and futile surgeries.
Objectives: To evaluate the economic impact and cost effectiveness of PET scanning in
the management of potentially operable NSCLC patients using a cost-utility model.
Methods: A literature review was conducted to find relevant studies and appropriate
parameters to construct a decision model. Two strategies were compared. The first
strategy was a conventional work up (CWU) consisting of an x-ray, a chest computer
tomography (CT) scan and brochoscopy; the second strategy consisted of a CWU plus a
whole body PET scan. These two strategies were applied to two sub-groups of NSCLC
patients; those that had received a positive result on their CT scan and those that got a
negative result on their CT scan. The cost-effectiveness of each strategy was dependent
on a number of variables that were taken from a literature review. Costs were based on
the Australian diagnostic related groups, a cost calculation for a chemotherapy course and
values obtained from the literature. The life expectancy and utility scores were also taken
from the literature and combined to create an incremental quality adjusted life year
(QALY) value for PET for each of the patient groups.
Results: The mean costs in CT negative and CT positive patients were lower in the CWU
strategy, costing $A 20,427 and $A 23,578 per patient respectively compared to the PET
strategy ($A 20,826 and $A 24,083 per patient respectively). The mean QALYs for both
the CT positive and CT negative patients were higher in PET with 2.91 and 2.11
respectively compared to the CWU of 2.88 and 2.09. The incremental cost effectiveness
ratio (ICER) for the CT negative strategy was $A 14,581 and $A 52,039 for the CT
positive strategy.
Conclusion: The PET strategy in CT negative and CT positive patients appears to be cost
effective, however, there is much uncertainty surrounding this base result, particularly in
CT positive patients.