JNM: 18F-FDG PET+CT cost-effective in screening head and neck cancer patients

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Whole-body 18F-FDG PET combined with chest CT is cost-effective in pretreatment screening for distant metastases in head and neck squamous cell carcinoma (HNSCC) patients with risk factors, according to a study published in the February issue of the Journal of Nuclear Medicine.

The presence of distant metastases at initial evaluation influences the prognosis and the treatment choice in HNSCC patients and hybrid PET/CT scanners was superior in sensitivity and cost effective when compared to FDG PET and CT alone, according to Otto S. Hoekstra, MD, PhD, of the VU University Medical Center in Amsterdam.

In the study, 145 patients underwent chest CT and whole-body 18F-FDG PET for screening of distant metastases. The researchers analyzed the cost data of 80 patients in whom distant metastases developed or who had a follow-up of at least 12 months.

Hoekstra said that cost-effectiveness analysis, including sensitivity analysis, was performed to compare the results of 18F-FDG PET, CT and a combination of CT and 18F-FDG PET.

Hoekstra and colleagues identified distant metastases in 21 percent of patients by pretreatment screening.

According to Hoekstra and colleagues, CT plus 18F-FDG PET had the highest sensitivity of 63 percent, while 18F-FDG PET had a sensitivity of 53 percent versus 37 percent with CTand positive predictive value of 80 percent versus 75 percent with CT.

“CT + 18F-FDG PET resulted in savings between  €203 ($303) and  €604 ($903) ”, wrote Hoekstra and colleagues.

The average costs in the CT + 18F-FDG PET group was found to be €37,954 ($56,801) in the first year after screening, € 38,558 ( $57,705) with CT alone and €38,355 ($57,402) with 18F-FDG PET alone.

The prices of 18F-FDG PET and hospital days could differ between countries and could be higher in other countries, noted Hoekstra and colleagues. However, “the most important value of 18F-FDG PET lies in offering patients a better (and more efficient) diagnostic strategy,” concluded Hoekstra and colleagues.