The Quarterly Journal of Nuclear Medicine and Molecular Imaging 2004 March;48(1):49-61

Copyright © 2009 EDIZIONI MINERVA MEDICA

lingua: Inglese

Economic analyses on the use of positron emission tomography for the work-up of solitary pulmonary nodules and for staging patients with non-small-cell-lung-cancer in Italy

Gugiatti A. ¹, Grimaldi A. ², Rossetti C. ³, Lucignani G. ⁴, De Marchis D. ², Borgonovi E. ¹, Fazio F. ²

¹ Cergas, Bocconi University, Milan, Italy 2 IBFM-CNR, Scientific Institute H San Raffaele and University of Milano-Bicocca, Milan, Italy 3 Oncology Department Niguarda Ca’ Granda Hospital, Milan, Italy 4 Institute of Radiological Sciences University of Milan and European Institute of Oncology Milan, Italy

Aim. Increasing age­ing of the pop­u­la­tion and ­tumor inci­dence, ­along ­with world­wide ration­ing of the resourc­es for pub­lic ­health ­systems, ­spur the use of eco­nom­ic anal­y­ses for the ­choice of strat­e­gies and tech­nol­o­gies in the assess­ment and man­age­ment of can­cer ­patients. Incidence and clin­i­cal man­ag­ing of ­tumors ­vary in dif­fer­ent coun­tries ­even if posi­tron emis­sion tomog­ra­phy (PET) ­with 2-­deoxy-2-[18F]-flu­o­ro-D-glu­cose (FDG) is becom­ing a rou­tine clin­i­cal meth­od for diag­no­sis, stag­ing, treat­ment mon­i­tor­ing and fol­low-up in a varie­ty of ­tumors. Available ­data indi­cate ­that PET can be con­sid­ered a super­i­or alter­na­tive or com­ple­men­tary ­tool to oth­er ­well-estab­lished meth­ods. However, in ­spite of the ­above and of the rap­id­ly increas­ing num­ber of PET cen­ters in Europe, USA and Japan, ­only a few stud­ies ­have ­dealt ­with ­some of the eco­nom­ic ­aspects ­raised by the clin­i­cal use of PET ­because of dif­fer­enc­es in val­ues of reim­burse­ments and ­health ­costs. The ­main aim of ­this ­study is to pro­pose and dis­cuss an eco­nom­ic mod­el of anal­y­sis for PET appli­ca­tions in the ­field of detec­tion and man­age­ment of pul­mo­nary ­tumors.
Methods. In ­this ­study 2 assess­ments ­were per­formed by deci­sion ­tree anal­y­sis on the eco­nom­ic ­impact of the avail­abil­ity of PET on deci­sion-mak­ing pro­cess­es for 2 con­di­tions: sol­i­tary pul­mo­nary nod­ules assess­ment and non-­small-­cell ­lung can­cer (­NSCLC) stag­ing. In ­order to ­define a meth­o­dol­o­gy con­sis­tent ­with the ­system of reim­burse­ment and the prev­a­lent clin­i­cal ­views of the Italian National Health Service, ­data on ­costs, ­death prob­abil­ity, and ­life expec­tan­cy ­were gath­ered ­from the lit­er­a­ture and ­from the Italian ­system of reim­burse­ment (ROD-DRGs).
Results. The ­results of the ­cost min­i­miza­tion anal­y­sis dem­on­strate ­that the use of PET in the diag­nos­tic ­path for the work­up of ­patients ­with SPN reduc­es the over­all diag­nos­tic ­costs, by approx­i­mate­ly 50 Euro per ­patient, by reduc­ing inap­pro­pri­ate inva­sive diag­nos­tic inves­ti­ga­tion and ­their com­pli­ca­tions. The ­results of the ­cost effec­tive­ness anal­y­sis dem­on­strate ­that the use of PET in the diag­nos­tic ­path for the stag­ing of ­patients ­with ­NSCLC reduc­es the over­all diag­nos­tic ­costs by approx­i­mate­ly 108 Euro for add­ed ­year, by reduc­ing inap­pro­pri­ate sur­gi­cal inter­ven­tions and ­their com­pli­ca­tions.
Conclusion. Both anal­y­ses are ­based on stan­dard meth­ods ­used in the lit­er­a­ture, so our con­clu­sions can be com­pared ­with ­results and assess­ments of sim­i­lar stud­ies in dif­fer­ent coun­tries and ­health ­care ­systems. Also in the Italian ­case, the use of an eco­nom­ic assess­ment pro­vides rel­e­vant infor­ma­tion on the effi­ca­cy and effec­tive­ness of PET.