Division of Cancer Services, Princess Alexandra Hospital, Brisbane, Australia.
Head Neck. 2013 Sep;35(9):1287-94. doi: 10.1002/hed.23108. Epub 2012 Sep 18.
The aim of this economic analysis was to model different strategies using pre-treatment nodal stage or nodal response assessment with CT or positron emission tomography (PET)/CT to determine the need for neck dissection.
A cost-minimization analysis was developed on the basis of probability data from a prospective study of PET-guided management of the neck in patients achieving a complete response at the primary site. Costs were derived from our institution's activity-based clinical costing system. The effect of uncertainty was tested with sensitivity and scenario analyses including nationally representative cost data.
Strategies incorporating PET had a 7% rate for neck dissection compared with 44% for CT-guided and 90% for planned neck dissection. The cost per patient was A$16,502 for planned neck dissection, A$8014 for CT-guided, and A$2573 for PET-guided. A policy with PET used only for incomplete response on CT was the least-cost strategy (A$2111). Policies incorporating PET remained the most efficient for all sensitivity/scenario analyses.
The incorporation of PET/CT into nodal response assessment significantly reduced the number of unnecessary neck dissections and generated considerable cost savings in our cohort.
本经济分析旨在通过使用 CT 或正电子发射断层扫描（PET）/CT 进行治疗前淋巴结分期或淋巴结反应评估来制定不同的策略，以确定是否需要进行颈部清扫术。
根据一项前瞻性研究中关于 PET 指导颈部管理的概率数据，在基于活动的临床成本核算系统的基础上制定了成本最小化分析。采用敏感性分析和情景分析对不确定性进行了测试，其中包括具有代表性的全国性成本数据。
与 CT 引导和计划颈部清扫组（分别为 44%和 90%）相比，纳入 PET 的策略组颈部清扫的比例为 7%。计划颈部清扫的每位患者的费用为 16502 澳元，CT 引导的费用为 8014 澳元，PET 引导的费用为 2573 澳元。仅对 CT 显示不完全反应的患者使用 PET 的策略是成本最低的策略（2111 澳元）。在所有敏感性/情景分析中，纳入 PET 的策略仍然是最有效的策略。
在淋巴结反应评估中纳入 PET/CT 可显著减少不必要的颈部清扫术数量，并为我们的患者群体带来显著的成本节约。
