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World Journal of Radiology World Journal of W J R Radiology Online Submissions: http://www.wjgnet.com/esps/ World J Radiol 2014 March 28; 6(3): 48-55 [email protected] ISSN 1949-8470 (online) doi:10.4329/wjr.v6.i3.48 © 2014 Baishideng Publishing Group Co., Limited. All rights reserved. BRIEF ARTICLE Cost-effectiveness of Fluorine-18-Fluorodeoxyglucose positron emission tomography in tumours other than lung cancer: A systematic review Salvatore Annunziata, Carmelo Caldarella, Giorgio Treglia Salvatore Annunziata, Carmelo Caldarella, Institute of Nu- lected concerning basic study, type of tumours evalu- clear Medicine, Catholic University of the Sacred Heart, 00168 ated, perspective/type of study, results, unit and com- Rome, Italy parison alternatives. Giorgio Treglia, Department of Nuclear Medicine and PET/CT Center, Oncology Institute of Southern Switzerland, 6500 Bell- RESULTS: Sixteen studies were included. Head and inzona, Switzerland neck tumours were evaluated in 4 articles, lymphoma Author contributions: All authors contributed to the manu- script. in 4, colon-rectum tumours in 3 and breast tumours in 2. Correspondence to: Salvatore Annunziata, MD, Institute Only one article was retrieved for melanoma, oesopha- of Nuclear Medicine, Catholic University of the Sacred Heart, gus and ovary tumours. Cost-effectiveness results of Largo Gemelli 8, 00168 Rome, Italy. [email protected] FDG-PET or PET/CT ranged from dominated to domi- Telephone: +39-63-0154978 Fax: +39-63-013745 nant. Received:November 2, 2013 Revised: December 31, 2013 Accepted: February 16, 2014 CONCLUSION: Literature evidence about the cost- Published online: March 28, 2014 effectiveness of FDG-PET or PET/CT in tumours other than lung cancer is still limited. Nevertheless, FDG- PET or PET/CT seems to be cost-effective in selective indications in oncology (staging and restaging of head Abstract and neck tumours, staging and treatment evaluation in AIM: To systematically review published data on the lymphoma). cost-effectiveness of Fluorine-18-Fluorodeoxyglucose positron emission tomography (FDG-PET) or PET/com- © 2014 Baishideng Publishing Group Co., Limited. All rights puted tomography (PET/CT) in tumours other than lung reserved. cancer. Key words: Positron emission tomography; Positron METHODS: A comprehensive literature search of stud- emission tomography /computed tomography; Fluorine- ies published in PubMed/MEDLINE, Scopus and Embase 18-Fluorodeoxyglucose; Cost-effectiveness; Oncology databases through the 10th of October in 2013 was car- ried out. A search algorithm based on a combination of Core tip: Evidence based data about the cost-effective- the terms: (1) “PET” or “ PET/computed tomography ness of Fluorine-18-Fluorodeoxyglucose positron emis- (PET/CT)” or “positron emission tomography”; and (2) sion tomography (FDG-PET) or PET/computed tomog- “cost-effectiveness” or “cost-utility” or “cost-efficacy” or raphy (PET/CT) in lung cancer already exist. The aim of “technology assessment” or “health technology assess- our study is to systematically review published data on ment” was used. Only cost-effectiveness or cost-utility the cost-effectiveness of FDG-PET or PET/CT in tumours analyses in English language were included. Exclusion other than lung cancer. criteria were: (1) articles not within the field of interest of this review; (2) review articles, editorials or letters, conference proceedings; and (3) outcome evaluation Annunziata S, Caldarella C, Treglia G. Cost-effectiveness of studies, cost studies or health technology assessment Fluorine-18-Fluorodeoxyglucose positron emission tomography reports. For each included study, information was col- in tumours other than lung cancer: A systematic review. World WJR|www.wjgnet.com 48 March 28, 2014|Volume 6|Issue 3| Annunziata S et al . Cost-effectiveness of PET in oncology J Radiol 2014; 6(3): 48-55 Available from: URL: http://www. cost-effectiveness of PET or PET/CT in patients with wjgnet.com/1949-8470/full/v6/i3/48.htm DOI: http://dx.doi. either histologically proven or suspected tumours other org/10.4329/wjr.v6.i3.48 than lung cancer. A search algorithm based on a combination of the terms: (1) “PET” or “PET/CT” or “positron emission tomography”; and (2) “cost-effectiveness” or “cost- INTRODUCTION utility” or “cost-efficacy” or “technology assessment” or “health technology assessment (HTA)” was used. No Fluorine-18-Fluorodeoxyglucose positron emission to- beginning date limit was used and the search was updated mography (FDG-PET) or PET/computed tomography th until October 10 , 2013. To expand our search, refer- (PET/CT) is useful imaging techniques to study cellular ences of the retrieved articles were also screened for ad- metabolism. FDG is a glucose analogue which is trapped ditional studies. Only English studies were included. by cells the glucose transporters; tumour cells usually via All studies or subsets in studies investigating the cost- show increased glucose metabolism and consequently an effectiveness of FDG-PET or PET/CT in patients with increased FDG uptake compared to normal cells. This suspected tumours other than lung cancer were eligible characteristic allows the visualization of tumour cells by [1] for inclusion. using PET imaging . The exclusion criteria were: (1) articles not within the To date, oncology is the most important application field of interest of this review; (2) review articles, editori- of FDG-PET and PET/CT. The role of FDG-PET or als or letters, comments, conference proceedings; and (3) PET/CT in oncology is to stage or restage tumours, to outcome evaluation studies, cost studies or health tech- evaluate tumour response to treatment, to define patient [1] nology assessment reports. prognosis, to guide surgery and radiotherapy . Three researchers (GT, SA and CC) independently FDG-PET and PET/CT have high costs; therefore it reviewed the titles and the abstracts of the retrieved is mandatory to combine the effectiveness evaluation of articles, applying the inclusion and exclusion criteria these methods with economic assessment in different on- mentioned above. The same three researchers then inde- cologic indications, in order to establish the correct use- [2] pendently reviewed the full-text version of the articles to fulness of these methods in different clinical scenarios . confirm their eligibility for inclusion. Disagreements were Cost-effectiveness analysis is a way to study both ef- resolved in a consensus meeting. ficacy and cost of a medical procedure. These studies use For each included study, information was collected parameters as “life years gained” (LYG) or disability days concerning basic study (author names, journal, year of saved. In cost-utility analysis, measures change with pa- publication, country of origin), type of tumours evalu- tient preference and authors refer to “quality-adjusted life ated, perspective/type of study, results, unit and compari- years” (QALYs). In cost-benefit analyses, monetary units son alternatives. represent the value of the procedure[3]. Incremental cost- effectiveness ratio (ICER) and incremental cost-utility ratio (ICUR) are ways to measure the cost of an increas- RESULTS ing efficacy (or utility) of a medical procedure. Similarly, The comprehensive computer literature search revealed net monetary benefit (NMB) is used to correlate cost and 874 articles. Reviewing titles and abstracts, 841 articles efficacy, using an equation including the willingness to were excluded applying the criteria mentioned above. pay (WTP) value that represents the maximum cost that a Thirty-three articles were selected and retrieved in full- patient would pay for a medical procedure. text version (Figure 1). One study was found screening Evidence based data about the cost-effectiveness of the references[6] and 18 articles were subsequently ex- FDG-PET and PET/CT in lung cancer already exist. cluded[7-24]. Finally, 16 studies were included[6,25-39]. The PET is cost-effective in staging of non-small cell lung characteristics of the included studies (Table 1) and a list carcinoma (NSCLC) and seems to be cost-effective for of excluded studies on economic evaluation assessment, diagnosing solitary pulmonary nodules (SPN)[4]. Then, with reasons for exclusion (Table 2) are provided. PET cost is appropriate in staging of lung cancer and di- Head and neck tumours were evaluated in 4 articles, agnosis of indeterminate SPNs[5]. lymphoma in 4, colon-rectum tumours in 3 and breast tu- Cost-effectiveness studies have been published about mours in 2. Only one article was retrieved for melanoma, the use of FDG-PET or PET/CT in tumours other than oesophageal and ovary tumours. lung cancer. The aim of our study is to systematically review published data on the cost-effectiveness of FDG- Cost-effectiveness of FDG-PET or PET/CT in head and PET and PET/CT in this setting. neck tumours Hollenbeak et al[25] compared PET with CT scan strat- egy in patients with N0 head and neck squamous cell MATERIALS AND METHODS carcinoma (HNSCC). A cost-effectiveness analysis was A comprehensive computer literature search of the undertaken using a decision tree model approach and the PubMed/MEDLINE, Scopus and Embase databases was perspective was that of the hospital. The ICER for the carried out to find relevant peer reviewed articles on the PET strategy was $8718 per year of life saved, or $2505 WJR|www.wjgnet.com 49 March 28, 2014|Volume 6|Issue 3| Annunziata S et al . Cost-effectiveness of PET in oncology Table 1 Characteristics of included studies Ref. Year Country Tumour (histology)
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