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Cost-effectiveness of adding FDG-PET or CT to the diagnostic work-up of patients with stage III melanoma.
Ann Surg. 2012 Apr; 255(4):771-6.AnnS

Abstract

OBJECTIVE

The aim of this prospective study was to assess predictive value of fludeoxyglucose-positron emission tomography (FDG-PET) and computed tomography (CT) and to analyze their cost-effectiveness in several diagnosis-treatment combinations.

BACKGROUND

The incidence of melanoma continues to rise. A proportion will present or recur with lymph node metastases (American Joint Committee on Cancer/Union for International Cancer Control stage III). To detect distant metastases, CT and/or FDG-PET are available. However, few studies have assessed their value and costs in stage III.

METHODS

All consecutive patients with melanoma with palpable, proven lymph node metastases (2003-2008) referred for examination with FDG-PET and CT were prospectively included. Sensitivity, specificity, and accuracy, and positive predictive value (PPV) and negative predictive value (NPV) were calculated. In economic evaluation, the costs of diagnostic work-up with and without FDG-PET and CT were compared.

RESULTS

Overall, 253 patients with melanoma were included. FDG-PET showed a higher sensitivity than CT: 86.1% compared with 78.2%. Specificity was higher for CT (93.7%) compared with FDG-PET (93.1%). Overall, FDG-PET showed a higher PPV and NPV. Cost-consequence analysis showed that adding CT (True-Positive upstaging in 61 patients) to diagnostic work-up decreased cost by 5.5%, adding FDG-PET (True-Positive upstaging in 68 patients) increased cost by 7.2%, and adding both (True-Positive upstaging in 78 patients) increased cost by 15.1%.

CONCLUSIONS

In this study, FDG-PET had higher sensitivity and predictive value, whereas CT had a higher specificity. Adding one of these diagnostic tools improved the staging of stage III patients with less than 10% cost increase. A proposal for stage-specific use of imaging modalities for clinicians caring for patients with melanoma is presented.

Authors+Show Affiliations

Department of Surgical Oncology, VU University Medical Centre, Amsterdam, The Netherlands.No affiliation info availableNo affiliation info availableNo affiliation info availableNo affiliation info availableNo affiliation info availableNo affiliation info availableNo affiliation info availableNo affiliation info availableNo affiliation info available

Pub Type(s)

Clinical Trial
Comparative Study
Journal Article

Language

eng

PubMed ID

22367443

Citation

Bastiaannet, Esther, et al. "Cost-effectiveness of Adding FDG-PET or CT to the Diagnostic Work-up of Patients With Stage III Melanoma." Annals of Surgery, vol. 255, no. 4, 2012, pp. 771-6.
Bastiaannet E, Uyl-de Groot CA, Brouwers AH, et al. Cost-effectiveness of adding FDG-PET or CT to the diagnostic work-up of patients with stage III melanoma. Ann Surg. 2012;255(4):771-6.
Bastiaannet, E., Uyl-de Groot, C. A., Brouwers, A. H., van der Jagt, E. J., Hoekstra, O. S., Oyen, W., Verzijlbergen, F., van Ooijen, B., Thompson, J. F., & Hoekstra, H. J. (2012). Cost-effectiveness of adding FDG-PET or CT to the diagnostic work-up of patients with stage III melanoma. Annals of Surgery, 255(4), 771-6. https://doi.org/10.1097/SLA.0b013e31824a5742
Bastiaannet E, et al. Cost-effectiveness of Adding FDG-PET or CT to the Diagnostic Work-up of Patients With Stage III Melanoma. Ann Surg. 2012;255(4):771-6. PubMed PMID: 22367443.
* Article titles in AMA citation format should be in sentence-case
TY - JOUR T1 - Cost-effectiveness of adding FDG-PET or CT to the diagnostic work-up of patients with stage III melanoma. AU - Bastiaannet,Esther, AU - Uyl-de Groot,Carin A, AU - Brouwers,Adrienne H, AU - van der Jagt,Eric J, AU - Hoekstra,Otto S, AU - Oyen,Wim, AU - Verzijlbergen,Fred, AU - van Ooijen,Bart, AU - Thompson,John F, AU - Hoekstra,Harald J, PY - 2012/2/28/entrez PY - 2012/3/1/pubmed PY - 2012/7/17/medline SP - 771 EP - 6 JF - Annals of surgery JO - Ann Surg VL - 255 IS - 4 N2 - OBJECTIVE: The aim of this prospective study was to assess predictive value of fludeoxyglucose-positron emission tomography (FDG-PET) and computed tomography (CT) and to analyze their cost-effectiveness in several diagnosis-treatment combinations. BACKGROUND: The incidence of melanoma continues to rise. A proportion will present or recur with lymph node metastases (American Joint Committee on Cancer/Union for International Cancer Control stage III). To detect distant metastases, CT and/or FDG-PET are available. However, few studies have assessed their value and costs in stage III. METHODS: All consecutive patients with melanoma with palpable, proven lymph node metastases (2003-2008) referred for examination with FDG-PET and CT were prospectively included. Sensitivity, specificity, and accuracy, and positive predictive value (PPV) and negative predictive value (NPV) were calculated. In economic evaluation, the costs of diagnostic work-up with and without FDG-PET and CT were compared. RESULTS: Overall, 253 patients with melanoma were included. FDG-PET showed a higher sensitivity than CT: 86.1% compared with 78.2%. Specificity was higher for CT (93.7%) compared with FDG-PET (93.1%). Overall, FDG-PET showed a higher PPV and NPV. Cost-consequence analysis showed that adding CT (True-Positive upstaging in 61 patients) to diagnostic work-up decreased cost by 5.5%, adding FDG-PET (True-Positive upstaging in 68 patients) increased cost by 7.2%, and adding both (True-Positive upstaging in 78 patients) increased cost by 15.1%. CONCLUSIONS: In this study, FDG-PET had higher sensitivity and predictive value, whereas CT had a higher specificity. Adding one of these diagnostic tools improved the staging of stage III patients with less than 10% cost increase. A proposal for stage-specific use of imaging modalities for clinicians caring for patients with melanoma is presented. SN - 1528-1140 UR - https://www.unboundmedicine.com/medline/citation/22367443/Cost_effectiveness_of_adding_FDG_PET_or_CT_to_the_diagnostic_work_up_of_patients_with_stage_III_melanoma_ L2 - https://Insights.ovid.com/pubmed?pmid=22367443 DB - PRIME DP - Unbound Medicine ER -