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Original Research: NEOPLASTIC DISEASE |

Cost and Outcomes of Patients With Solitary Pulmonary Nodules Managed With PET Scans

Paul G. Barnett, PhD; Lakshmi Ananth, MS; Michael K. Gould, MD, MS; for the Veterans Affairs Positron Emission Tomography Imaging in the Management of Patients with Solitary Pulmonary Nodules (VA SNAP) Cooperative Study Group
Author and Funding Information

From the Health Economics Resource Center (Dr Barnett and Ms Ananth), VA Palo Alto Health Care System (Dr Gould), Palo Alto; and the Stanford School of Medicine (Drs Barnett and Gould), Stanford, CA.

Correspondence to: Paul G. Barnett, PhD, Health Economics Resource Center, 795 Willow Rd (152), Menlo Park, CA 94025; e-mail: paul.barnett@va.gov


For editorial comments see page 4

Funding/Support: This study was supported by the US Department of Veterans Affairs Cooperative Studies Program, Office of Research and Development (VA Cooperative Study 027).

Reproduction of this article is prohibited without written permission from the American College of Chest Physicians (www.chestjournal.org/site/misc/reprints.xhtml).


© 2010 American College of Chest Physicians


Chest. 2010;137(1):53-59. doi:10.1378/chest.08-0529
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Background:  No prior study to our knowledge has observed the cost of managing solitary pulmonary nodules of patient groups defined by PET scan results.

Methods:  We combined study and administrative data over 2 years of follow-up.

Results:  Of 375 individuals with a definitive diagnosis, 54.4% had a malignant nodule and 62.1% had positive PET scan results. Mortality risk was 5.0 times higher (CI, 3.1-8.2) and cost was greater ($50,233 vs $22,461, P<.0001) among patients with malignant nodule. Mortality risk was 4.1 times higher (CI, 2.4-7.0) and cost was greater ($47,823 vs $20,744, P<.0001) among patients with a positive PET scan result. Among patients with a malignant nodule, 4.9% had a false-negative PET scan, but cost and survival were not different from true positives. Among patients with a benign nodule, 22.8% had a false-positive PET scan. These patients had greater cost ($33,783 vs $19,115, P<.01), more surgeries and biopsies, and 3.8 times the mortality risk (CI, 1.6-9.2) of true negatives. Just over one-half (54.5%) of individuals with positive PET scans received surgery. Most individuals with negative PET scans (85.2%) were managed by watchful waiting. They incurred fewer costs than patients with negative PET scans who were managed more aggressively ($19,378 vs $28,611, P<.01).

Conclusions:  Management of solitary pulmonary nodules is expensive, especially if the nodule is malignant or if the PET scan result is false positive. Among patients with malignant nodules, 2-year survival is poor. Compared with true-positive PET scan results, false-negative results are not associated with lower costs or better outcomes.


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