Solitary pulmonary nodules: accuracy and cost-effectiveness of sodium iodide FDG-PET using Australian data

Abstract

This study uses Australian data to confirm the accuracy of dedicated sodium iodide (NaI) fluorine-18 fluorodeoxyglucose positron emission tomography (FDG-PET) in evaluating indeterminate solitary pulmonary nodules (SPNs) and to determine the conditions under which PET could play a cost-effective role in this evaluation. Ninety-two patients from two Australian hospitals in different states underwent FDG-PET for evaluation of an SPN. Observed values for prior probability of malignancy and diagnostic accuracy of PET were applied to previously published decision tree models using published Australian health care costs. The accuracy of FDG-PET was 93% with a sensitivity of 92% and a specificity of 95%. The prior probability of malignancy (0.54), PET sensitivity and PET specificity indicated cost savings per patient of up to EUR 455 (Adollars 774) based on a PET cost of EUR 706 (Adollars 1,200). PET would remain cost-effective for levels of prior probability up to 0.8-0.9 and a PET cost of EUR 736-1,161 (Adollars 1,252-Adollars 1,974). It is concluded that NaI PET is accurate, cost saving and cost-effective for the characterisation of indeterminate pulmonary nodules in Australia. Comparison with previous reports from the United States confirms that FDG-PET can remain cost-effective despite population differences in medical costs, disease prevalence and PET diagnostic performance.

Cost and Outcomes of Patients With Solitary Pulmonary Nodules Managed With PET Scans

“…The cost-effectiveness of this trade-off has been evaluated with clinical decision models. [10][11][12][13][14][15] Models could be improved with more accurate information on cost.…”

Impact of FDG-PET for staging of oesophageal cancer

“…The improvement of the staging procedure by FDG-PET will probably save money, due to reduction of radiochemotherapy and operations that are not indicated. It is known from investigations of non-small cell lung cancer patients that PET can be cost-effective when included in a diagnostic system instead of being performed just in addition to the established diagnostic procedures [24][25][26]. In EC it might be favourable for PET to be performed after CT and US only in patients who qualified at this point for operation and/or neoadjuvant protocol.…”

The value of BAL fluid LDH level in differentiating benign from malignant solitary pulmonary nodules

“…In our study, a SPN was deWned as a single, noncalciWed, well-circumscribed, spherical radiographic opacity that measures 1-4 cm in diameter and is surrounded completely by aerated lung (Gambhir et al 1998;Keith et al 2002). There is no associated pulmonary inWltration, hilar enlargement, atelectasis, or pleural eVusion.…”