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.
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
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.
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.