PET-Based Staging Is Cost-Effective in Early-Stage Follicular Lymphoma

Lo, AC; James, LP; Prica, A; Raymakers, A; Peacock, S; Qu, M; Louie, AV; Savage, KJ; Sehn, LH; Hodgson, D; Yang, JC; Eich, HTT; Wirth, A; Hunink, MGM

Author(s): Lo, AC; James, LP; Prica, A; Raymakers, A; Peacock, S; Qu, M; Louie, AV; Savage, KJ; Sehn, LH; Hodgson, D; Yang, JC; Eich, HTT; Wirth, A; Hunink, MGM;
Details: Publication Year 2022-04,Volume 63,Issue #4,Page 543-548
Journal Title: Journal of Nuclear Medicine
Publication Type: Research article
Abstract: The objective was to assess the cost-effectiveness of staging PET/CT in early-stage follicular lymphoma (FL) from the Canadian health-care system perspective. Methods: The study population was FL patients staged as early-stage using conventional CT imaging and planned for curative-intent radiation therapy (RT). A decision analytic model simulated the management after adding staging PET/CT versus using staging CT alone. In the no-PET/CT strategy, all patients proceeded to curative-intent RT as planned. In the PET/CT strategy, PET/CT information could result in an increased RT volume, switching to a noncurative approach, or no change in RT treatment as planned. The subsequent disease course was described using a state-transition cohort model over a 30-y time horizon. Diagnostic characteristics, probabilities, utilities, and costs were derived from the literature. Baseline analysis was performed using quality-adjusted life years (QALYs), costs (2019 Canadian dollars), and the incremental cost-effectiveness ratio. Deterministic sensitivity analyses were conducted, evaluating net monetary benefit at a willingness-to-pay threshold of $100,000/QALY. Probabilistic sensitivity analysis using 10,000 simulations was performed. Costs and QALYs were discounted at a rate of 1.5%. Results: In the reference case scenario, staging PET/CT was the dominant strategy, resulting in an average lifetime cost saving of $3,165 and a gain of 0.32 QALYs. In deterministic sensitivity analyses, the PET/CT strategy remained the preferred strategy for all scenarios supported by available data. In probabilistic sensitivity analysis, the PET/CT strategy was strongly dominant in 77% of simulations (i.e., reduced cost and increased QALYs) and was cost-effective in 89% of simulations (i.e., either saved costs or had an incremental cost-effectiveness ratio below $100,000/QALY). Conclusion: Our analysis showed that the use of PET/CT to stage early-stage FL patients reduces cost and improves QALYs. Patients with early-stage FL should undergo PET/CT before curative-intent RT.
Keywords: Canada; Cost-Benefit Analysis; Humans; *Lymphoma, Follicular/diagnostic imaging/radiotherapy; *Positron Emission Tomography Computed Tomography; Quality-Adjusted Life Years; Pet/ct; cost-effectiveness analysis; follicular lymphoma; radiation therapy; staging
Department(s): Radiation Oncology
PubMed ID: 34413148
Publisher's Version: https://doi.org/10.2967/jnumed.121.262324
Terms of Use/Rights Notice: Refer to copyright notice on published article.

Creation Date: 2025-01-24 05:57:00

Last Modified: 2025-01-24 05:58:22