Chest

Chest

Volume 117, Issue 2, February 2000, Pages 346-353
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Clinical Investigations
Decision-Tree Sensitivity Analysis for Cost-Effectiveness of Chest 2-Fluoro-2-D-[18F]Fluorodeoxyglucose Positron Emission Tomography in Patients With Pulmonary Nodules (Non-small Cell Lung Carcinoma) in Japan

https://doi.org/10.1378/chest.117.2.346Get rights and content

Context

Recent studies have demonstrated the potential cost-effectiveness of using 2-fluoro-2-D-[18F]fluorodeoxyglucose (FDG) positron emission tomography (PET) in the management of non-small cell lung carcinoma (NSCLC), but because of differences in health-care systems, those findings may not hold true in a Japanese hospital.

Objective

To assess the cost-effectiveness of the chest CT plus chest FDG-PET strategy in Japan.

Design

Decision-tree sensitivity analysis based on the two competing strategies of chest CT–alone vs chest CT plus chest FDG-PET.

Study selection

A simulation of 1,000 patients in whom NSCLC, stage IIIB or less, was suspected was created using baselines of other relevant variables in regard to sensitivity, specificity, mortality, life expectancy, and cost from published data.

Methods

We surveyed the relevant literature for the choice of variables.

Main outcome measures

Expected marginal cost and expected life expectancy gain for NSCLC patients.

Results

The chest CT plus chest FDG-PET strategy yielded an expected life expectancy gain of 0.607 years (7.3 months) per patient, compared with the alternative strategy of chest CT–alone. Using an FDG-PET examination cost of 1.0 × 105 yen (around $700 US) per study, the cost increment was 2.18 × 105 yen/yr/patient.

Conclusions

The chest CT plus chest FDG-PET strategy in patients with NSCLC is unlikely to be cost-effective in Japan. However, patient life expectancy gain would increase as a result of improved staging of NSCLC. These preliminary results should be confirmed by further studies for specific environments.

Section snippets

Materials and Methods

Decision-tree sensitivity analysis was performed to determine expected marginal costs and expected life expectancy gain in NSCLC patients by using two competing strategies: (1) the chest CT–alone strategy, which is being utilized in most institutions in Japan, and (2) the new strategy of chest CT plus chest FDG-PET.

Results

The decision trees for the 1,000-patient simulation and the results are shown in Figures 1, 2, which show the decision trees for the chest CT–alone strategy and the chest CT plus chest FDG-PET strategy, respectively.

With the chest CT–alone strategy, 133 patients with resectable disease would undergo radiation therapy, and 55 patients with unresectable disease and 70 patients with benign disease would undergo an unnecessary attempt at curative surgery.

The chest CT plus chest FDG-PET strategy,

Discussion

The cost of medical care in Japan is rapidly increasing year by year, and it increased by 1 trillion yen a year in the 1990s. It is estimated that in 1999, medical care will cost more than 30 trillion yen, or approximately $2.14 × 1011 US—around 8% of the gross domestic product.

Our study may be criticized for using the baseline of 56 patients with pulmonary nodules who presented to the hospital during a 1-year period, because baseline data from a single hospital may raise the question of

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    Partially supported by funding from the Working Group Project of the Japanese Society of Nuclear Medicine.

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    Copyright © 2000 The American College of Chest Physicians. Published by Elsevier Inc. All rights reserved.