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Cost-effectiveness of FDG-PET in staging non-small cell lung cancer: the PLUS study

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Abstract

Currently, up to 50% of the operations in early-stage non-small cell lung cancer (NSCLC) are futile owing to the presence of locally advanced tumour or distant metastases. More accurate pre-operative staging is required in order to reduce the number of futile operations. The cost-effectiveness of fluorine-18 fluorodeoxyglucose positron emission tomography (18FDG-PET) added to the conventional diagnostic work-up was studied in the PLUS study. Prior to invasive staging and/or thoracotomy, 188 patients with (suspected) NSCLC were randomly assigned to conventional work-up (CWU) and whole-body PET or to CWU alone. CWU was based on prevailing guidelines. Pre-operative staging was followed by 1 year of follow-up. Outcomes are expressed in the percentage of correctly staged patients and the associated costs. The cost price of PET varied between €736 and €1,588 depending on the (hospital) setting and the procurement of 18FDG commercially or from on-site production. In the CWU group, 41% of the patients underwent a futile thoracotomy, whereas in the PET group 21% of the thoracotomies were considered futile (P=0.003). The average costs per patient in the CWU group were €9,573 and in the PET group, €8,284. The major cost driver was the number of hospital days related to recovery from surgery. Sensitivity analysis on the cost and accuracy of PET showed that the results were robust, i.e. in favour of the PET group. The addition of PET to CWU prevented futile surgery in one out of five patients with suspected NSCLC. Despite the additional PET costs, the total costs were lower in the PET group, mainly due to a reduction in the number of futile operations. The additional use of PET in the staging of patients with NSCLC is feasible, safe and cost saving from a clinical and from an economic perspective.

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Correspondence to Carin A. Uyl-de Groot.

Additional information

A list of other participants from the PLUS Study group is shown in the Appendix.

Appendix

Appendix

In addition to the authors, the PLUS Study Group participants were as follows: A. Boonstra, B. Venmans, A.J.M. van Boxem, G. Sutedja, R.A. Manoliu and R. Golding at the Academic Hospital Vrije Universiteit, Amsterdam; W.F.M. Strankinga, P.M. Hooghiemstra, F.C. Crezée and P.L. Tolenaar at the BovenIJ Ziekenhuis, Amsterdam; H.B. Kwa, J.G. van Unnik, R. Hardjowijono and S.S. Wagenaar at the Onze Lieve Vrouwe Gasthuis, Amsterdam; C. Jie, M.C.T.B. Sie, R.M.J.M. Butzelaar and M.N. Weimann at the Lucas Ziekenhuis, Amsterdam; G. Visschers, P.I. van Spiegel, G.C. Collet and R.P. Rademakers at the Slotervaart Ziekenhuis, Amsterdam; W.G. Boersma, M. Deenstra, C.S. de Graaff, T. Haitjema, G.H. Ooms and J.H. Pot at the Medisch Centrum Alkmaar; J. Prins, P.M.J.M. de Vries, E. Scheijde and J. Dijkstra at the Westfries Gasthuis, Hoorn; J.P. Teengs and E. Boerma at the Kennemer Gasthuis, Haarlem; and J. Berkovits, R.P.A. Boom and J Krekt at the Ziekenhuis Amstelveen.

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Verboom, P., van Tinteren, H., Hoekstra, O.S. et al. Cost-effectiveness of FDG-PET in staging non-small cell lung cancer: the PLUS study. Eur J Nucl Med Mol Imaging 30, 1444–1449 (2003). https://doi.org/10.1007/s00259-003-1199-9

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  • DOI: https://doi.org/10.1007/s00259-003-1199-9

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