Medical economics of whole-body FDG PET in patients suspected of having non-small cell lung carcinoma--reassessment based on the revised Japanese national insurance reimbursement system

• Published in: Annals of nuclear medicine Vol. 17; no. 8; pp. 649 - 655
• Main Authors: Abe, Katsumi, Kosuda, Shigeru, Kusano, Shoichi
• Format: Journal Article
• Language: English
• Published: Japan Springer Nature B.V 01.12.2003
• Subjects: Bone imaging; Brain; Breast cancer; Carcinoma, Non-Small-Cell Lung - diagnostic imaging; Carcinoma, Non-Small-Cell Lung - economics; Carcinoma, Non-Small-Cell Lung - epidemiology; Cost analysis; Cost control; Cost-Benefit Analysis - methods; Cost-Benefit Analysis - statistics & numerical data; Decision analysis; Decision trees; Female; Fluorodeoxyglucose F18 - economics; Hospitals; Humans; Insurance; Insurance, Health, Reimbursement - economics; Insurance, Health, Reimbursement - statistics & numerical data; Japan - epidemiology; Life expectancy; Life span; Lung cancer; Lung carcinoma; Lung Neoplasms - diagnostic imaging; Lung Neoplasms - economics; Lung Neoplasms - epidemiology; Lungs; Magnetic resonance imaging; Male; Medical imaging; Models, Econometric; National Health Programs - economics; National Health Programs - statistics & numerical data; National insurance; Neuroimaging; Non-small cell lung carcinoma; Patients; Positron emission; Positron emission tomography; Prevalence; Radiopharmaceuticals - pharmacokinetics; Reimbursement; Sensitivity analysis; Small cell lung carcinoma; Studies; Tomography, Emission-Computed - economics; Tomography, Emission-Computed - utilization; Whole-Body Counting - economics; Whole-Body Counting - utilization; United States > US
• ISSN: 0914-7187; 1864-6433
• DOI: 10.1007/bf02984970

Focusing on the savings expected from the revised Japanese national insurance reimbursement system in the management of patients suspected of having non-small cell lung carcinoma (NSCLC), cost-effectiveness was assessed using decision tree sensitivity analysis on the basis of the 2 competing strategies of whole-body FDG PET (WB-PET) and conventional imaging (CI). A WB-PET strategy that models dependence upon chest FDG PET scan, WB-PET scan, and brain MR imaging with contrast was designed. The cost of a FDG PET examination was updated and determined to be US dollar 625.00. The CI strategy involves a combination of conventional examinations, such as abdominal CT with contrast, brain MR imaging with contrast, and a whole-body bone scan. A simulation of 1,000 patients suspected of having NSCLC (Stages I to IV) was created for each strategy using a decision tree and baselines of other relevant variables cited from published data. By using the WB-PET strategy in place of the CI strategy for the management of patients suspected of having NSCLC in hospitals with an NSCLC prevalence of 75%, the cost saving (CS) for each patient would be US dollar 697.69 for an M1 prevalence of 20% and US dollar 683.52 for an M1 prevalence of 40%, but the CS gradually decreases as the NSCLC prevalence increases. The break-even point requires less than an 80% prevalence in order for the WB-PET strategy to gain life expectancy (LE) per patient. By using the WB-PET strategy in place of the CI strategy for the management of patients suspected of having NSCLC in hospitals with an NSCLC prevalence of 75%, the gain in LE for each patient would be 0.04 years (11.06 vs. 11.02 years) for an M1 prevalence of 20% and 0.10 years (10.13 vs. 10.03 years) for an M1 prevalence of 40%. The maximum cost of a PET study without losing LE would be US dollar 1322.68 per patient for prevalences of 75% NSCLC and 20% M1 disease. The present study quantitatively showed WB-PET, employed in place of CI for managing NSCLC patients, to be cost-effective in the Japanese revised insurance reimbursement system. However, the present cost is very low from the industrial viewpoint.