Institute for Medical Technology Assessment, Erasmus MC, University Medical Center Rotterdam, Rotterdam, The Netherlands.
J Nucl Med. 2010 Feb;51(2):176-82. doi: 10.2967/jnumed.109.067371.
The aim of the study was to define the cost-effectiveness of whole-body (18)F-FDG PET, as compared with chest CT, in screening for distant metastases in patients with head and neck squamous cell carcinoma (HNSCC).
In a multicenter prospective study, 145 consecutive patients with high risk factors for distant metastases and scheduled for extensive treatment underwent chest CT and whole-body (18)F-FDG PET for screening of distant metastases. The cost data of 80 patients in whom distant metastases developed or who had a follow-up of at least 12 mo were analyzed. Cost-effectiveness analysis, including sensitivity analysis, was performed to compare the results of (18)F-FDG PET, CT, and a combination of CT and (18)F-FDG PET (CT + (18)F-FDG PET).
Pretreatment screening identified distant metastases in 21% of patients. (18)F-FDG PET had a higher sensitivity (53% vs. 37%) and positive predictive value (80% vs. 75%) than did CT. CT + (18)F-FDG PET had the highest sensitivity (63%). The average costs in the CT, (18)F-FDG PET, and CT + (18)F-FDG PET groups amounted to euro38,558 (approximately $57,705), euro38,355 (approximately $57,402), and euro37,954 (approximately $56,801), respectively, in the first year after screening. CT + (18)F-FDG PET resulted in savings between euro203 (approximately $303) and euro604 (approximately $903). Sensitivity analysis showed that the dominance of CT + (18)F-FDG PET was robust.
In HNSCC patients with risk factors, pretreatment screening for distant metastases by chest CT is improved by (18)F-FDG PET. The combination of (18)F-FDG PET with CT is the most effective, without leading to additional costs.
本研究旨在比较全身 18F-FDG PET 与胸部 CT 筛查头颈部鳞状细胞癌（HNSCC）患者远处转移的成本效益。
在一项多中心前瞻性研究中，145 例高危远处转移的连续患者接受了胸部 CT 和全身 18F-FDG PET 筛查远处转移。分析了 80 例远处转移或至少随访 12 个月的患者的成本数据。进行成本效益分析，包括敏感性分析，以比较 18F-FDG PET、CT 和 CT+18F-FDG PET（CT+18F-FDG PET）的结果。
治疗前筛查发现 21%的患者存在远处转移。18F-FDG PET 的敏感性（53%对 37%）和阳性预测值（80%对 75%）均高于 CT。CT+18F-FDG PET 的敏感性最高（63%）。CT、18F-FDG PET 和 CT+18F-FDG PET 组的平均成本在第一年分别为 38558 欧元（约合 57705 美元）、38355 欧元（约合 57402 美元）和 37954 欧元（约合 56801 美元）。CT+18F-FDG PET 的节省额在 203 欧元（约合 303 美元）至 604 欧元（约合 903 美元）之间。敏感性分析表明，CT+18F-FDG PET 的优势是稳健的。
在有危险因素的 HNSCC 患者中，胸部 CT 检查的远处转移筛查可通过 18F-FDG PET 得到改善。18F-FDG PET 与 CT 的联合应用是最有效的，不会导致额外的成本。
