They identified a set of potential costs of PET as:
a) The cost of setting up and running a PET scanner.
b) A change in the number of correct operations in N0/N1 M0 patients due to the
specificity of PET and false positive results.
c) Additional costs of palliative care treatment to patients if given at an earlier stage.
d) Additional side effects of longer palliative care
Literature review
The literature was searched to identify any relevant cost effectiveness studies, reviews
and randomised control trials (RCT’s) concerning the use of FDG-PET in the staging of lung
cancer. The peer-reviewed databases that were searched were PubMed and Cochrane. The
relevant studies which were identified in the literature had their references hand searched and
assessed to ascertain if any relevant studies had been overlooked. The inclusion/exclusion
criteria were as follows:
Inclusion criteria
• Studies in English
• Studies published between 1990 and June 2007
• Studies using FDG as the radio-labelled tracer
• Cost effectiveness studies, cost utility studies or random control trials (RCTs) selected.
Exclusion Criteria
• Studies not focused on NSCLC
• Studies not relevant to the topic
There were 6 cost effectiveness studies and 3 cost utility studies identified, in addition
to 3 RCT’s.. A summary of the studies are given in the Appendix.
There were three cost utility studies that looked at the staging of PET with two of these
being from the UK and one from Japan. The first UK Study was conducted by Bradbury et al
for the Health Technology Board Scotland (HTBS)16 and the other UK study was undertaken
by the National Institute of Health and Clinical Effectiveness (NICE) in England and Wales.17
These studies are both very recent and they have built and improved upon previous studies to
give two comprehensive models using the available NSCLC literature. Furthermore, their use
of QALYs to take account of the differences in the patient morbidities found in the different
stages and treatments of NSCLC sets them apart from the cost effectiveness studies. Therefore,
the majority of the literature review will be based on these two studies. The third cost utility
study by Hayashi et al was less explicit on the sources of their data especially those concerning
the utilities used and so will only be briefly looked at below.
16 Bradbury et al. Health Technology Board Scotland, “Positron emission tomography (PET) imaging in cancer
management” October 2002.
17 National Institute of Health and Clinical Effectiveness, “The Diagnosis and treatment of Lung Cancer; Methods,
Evidence and Guidance. National Collaboration Centre of Acute Care. 2005.
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