An article published in the March issue of the Journal of  Nuclear Medicine reports on the methodologies for conducting economic evaluations of PET and PET/CT in oncologic applications, suggesting that PET and PET/CT are cost effective for staging of non–small cell lung cancer, differential diagnosis of solitary pulmonary nodules, restaging of Hodgkin's disease and non-Hodgkin's lymphoma and the restaging of colorectal carcinoma.

Healthcare systems globally have recently approved reimbursement for PET and PET/CT for staging of non-small cell lung cancer and differential diagnosis of solitary pulmonary nodules because PET and PET/CT have been found to be cost-effective for those uses, according to Andreas K. Buck, MD from Nuklearmedizinische Klinik und Poliklinik in München, Germany, and colleagues.

Additional indications that are covered by healthcare systems in the U.S. and several European countries include staging of gastrointestinal tract cancers, breast cancer, malignant lymphoma, melanoma, and head and neck cancers, added Buck and colleagues. PET and PET/CT are highly sensitive diagnostic tests to screen for metastatic tumor deposits in the entire body that may be missed by standard imaging modalities.

On a patient basis, costs for PET and PET/CT are decreasing with the increasing numbers of examinations performed, noted Buck and colleagues. In Germany, “costs per examination range between approximately € 600 ($885 U.S.) and €1,000 ($1,474 U.S.); the amount for production and delivery of radiopharmaceuticals is approximately €180–€ 260 ($265–$383 U.S.) per scan.”

In Great Britain, costs range from £635–£1,300 ($1,030– $2,109 U.S.) for PET. In Europe, reimbursement for PET and PET/CT examinations varies significantly depending on the respective healthcare systems, according to Buck and colleagues.

In the U.S., reimbursement for PET and PET/CT is provided by the Medicare program. “For examinations performed on inpatients or at hospital outpatient departments, a median amount of $952.83 is reimbursed. The amount consists of $855.43 for the examination and $97.40 for the analysis. Under certain conditions, additional costs for the production of radiopharmaceuticals are reimbursed,” wrote Buck and colleagues.

Commonly, there are three approaches toward economic evaluation, with the type of outcome measurement determining the approach: cost-effectiveness analysis (CEA), cost utility analysis (CUA), and cost-benefit analysis (CBA). However, CBA is still in its experimental stage and evaluation agencies usually prefer CEA and CUA, noted Buck and colleagues.

Initial studies have shown at least mild improvement of diagnostic accuracy, compared with separately performed CT and PET studies. Therefore, results obtained for PET can generally be extended to the PET/CT approach, adds Buck and colleagues.

There is a need for prospective, randomized clinical trials comprising high patient numbers to evaluate the clinical relevance and cost effectiveness of PET and PET/CT in other cancers such as breast cancer, melanoma, esophageal or gastric cancer, head and neck cancer, and bone and soft-tissue sarcomas. In addition, researchers may consider including cost-effectiveness studies in clinical studies because these are increasingly requested by decision makers, concluded Buck and colleagues.