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DOI: 10.1055/s-0038-1625924
Cost-effectiveness of PET for the management of lung tumours: Comparison of economic data
Kosteneffektivität der PET im Behandlungsalgorithmus der Lungentumoren: Ein Vergleich gesundheitsökonomischer DatenPublication History
Eingegangen:
00 February 2001
angenommen:
12 February 2001
Publication Date:
11 January 2018 (online)
![](https://www.thieme-connect.de/media/10.1055-s-00034924/200104/lookinside/thumbnails/10-1055-s-0038-1625924_de-1.jpg)
Summary
Modelling is an accepted, valid and often necessary method for assessing economic effectiveness in terms of cost per life year gained. Comparing an alternative strategy (a) with a baseline strategy (bl), the incremental cost (C0STa-C0STb|) divided by the incremental life expectancy (LEG-LEbï) defines the incremental cost-effectiveness ratio (ICER). Taking watchful waiting as the low-cost baseline strategy for the management of solitary pulmonary nodules, the ICER of positron emission tomography (PET) [3218 euros (EUR) per life year saved (LYS)] was more favourable than that of exploratory surgery (4210 EUR/LYS) or that of transthoracic needle biopsy (6120 EUR/LYS). Changing the baseline strategy to exploratory surgery, the use of PET led to cost savings and additional life expectancy in case of an intermediate pretest probability of malignancy. For management of potentially operable non-small cell lung cancer the use of PET in patients with normalisized mediastinal lymph nodes on CT was most cost-effective (143 EUR/LYS), and the costs of PET were almost balanced by a better selection of patients for beneficial cancer resection. Using PET in patients with enlarged lymph nodes on CT, the ICER raised to 36,667 EUR/LYS. When PET or CT were positive for mediastinal lymph nodes, the exclusion from biopsy confirmation led to cost savings that did not justify the expected reduction in life expectancy. Economic data from the USA and Japan also demonstrated the cost-effectiveness of PET-based algorithms for the management of lung tumours.
Zusammenfassung
Die Entscheidungsmodellierung ist eine in der Gesundheitsökonomie anerkannte und häufig notwendige Methode, um die Kosten in Relation zu den gewonnenen Lebensjahren bewerten zu können. Wird eine alternative Strategie (a) mit einer Basisstrategie (b) verglichen, so definiert die Kostendifferenz (K0STENG-K0STENb) geteilt durch die Differenz in der Lebenserwartung (LEG-LEb) die “incremental cost-effectiveness ratio” (ICER). Solange das kontrollierte Zuwarten die Basisstrategie bei der Dig-nitätsabklärung des solîtaren Lungenrundherdes darstellte, lag die ICER der Positronen-Emissions-Tomographie (PET) (3218 Euros [EUR] pro gewonnenes Lebensjahr [LYS = life year saved]) günstiger als die ICER der ex-plorativen Chirurgie (4210 EUR/LYS) oder die ICER der Feinnadelbiopsie (6120 EUR/LYS). Bildete die explorative Chirurgie die Basisstrategie, führte der PET-Algorith-mus zur Kostenreduktion und zu einem Lebenszeitgewinn, eine mittlere Vortestwahrscheinlichkeit für Malignität vorausgesetzt. Bei der Behandlung des potenziell operablen, nicht-kleinzelligen Bronchialkarzinoms erwies sich die PET bei Patienten mit normal großen me-diastinalen Lymphknoten im CT als sehr kosteneffektiv (143 EUR/LYS). Die Kosten der PET wurden durch die verbesserte Patientenauswahl zur primären Tumorresektion nahezu kompensiert. Bei Patienten mit nodal-positi-vem CT stieg die ICER auf 36 667 EUR/LYS: Nodal-positive PET- oder CT-Befunde bedurften der histologischen Verifizierung. Andernfalls ergäbe sich eine durch die ICERs nicht gerechtfertigte Verminderung der Lebenserwartung. Die gesundheitsökonomischen Daten aus den USA und Japan sprechen ebenfalls für eine Kosteneffek-livität der PET-basierten Algorithmen bei der Behandlung der Lungentumoren.
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