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Use of a decision analysis model to assess the medicoeconomic implications of FDG PET imaging in diagnosing a solitary pulmonary nodule

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Abstract

This study assessed the use of positron emission tomography (PET) in identifying and diagnosing solitary pulmonary nodules (SPNs). For this a decision analysis model was constructed, and three alternatives were compared: wait and watch (WW), PET and anatomical computed tomography (PET), and CT plus PET (CT+PET). Transition probabilities were estimated from published data and consultations with experts. Costs of diagnosis were derived from the French reimbursement scale, and treatment costs from a national hospital database of diagnosis-related groups. The base case was defined as a 65-year-old male smoker with a 2-cm SPN and an associated high risk of malignancy of 43%. Evaluation criteria included incremental cost-effectiveness ratios and the proportion of unnecessary operations avoided in patients without malignant SPN. For the base case WW was the least effective and cheapest strategy. CT+PET was more effective and presented lower incremental cost-effectiveness ratio (€3,022 per life-year gained). It also was superior to PET in cost-effectiveness terms and resulted in 4.3% fewer unnecessary resections of benign SPN than did PET. Risk profile analyses performed on SPN malignancy risk showed that CT + PET remains the most cost-effective strategy in the range of 5.7–87%, and that WW is more cost-effective in the range of 0.3–5.0%. CT+PET is thus cost-effective in detecting malignant SPN in patients with a risk of malignity of at least 5.7% and may avoid inappropriate resections of benign SPN. These findings support the attempts to introduce a larger number of PETs in France for SPN diagnosis.

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Acknowledgements

The following experts contributed to the choice of clinical parameters and the building of the decision tree: Dr. P. Arveux (epidemiologist), Pr. A. Bernard (thoracic surgeon), Pr. A. Bertrand (nuclear physician), Pr. P. Bey (radiotherapist), Dr. C. Binquet (biostatistician), Dr. A. Bizieux-Thaminy (pneumologist), Pr. S. Briançon (epidemiologist), Pr. F. Brunotte (nuclear physician), Pr. J.C. Cardot (nuclear physician), Pr. A. Constantinesco (nuclear physician), Pr. A. Depierre (pneumologist), Dr. P. Foucher (pneumologist), Pr. J.C. Grob (nuclear physician), Pr. F. Guillemin (epidemiologist), Pr. D. Jolly (epidemiologist), Pr. G. Karcher (nuclear physician), Pr. D. Krause (radiologist), Pr. J.C. Liehn (nuclear physician), Pr. Y. Martinet (pneumologist), Dr. O. Ménard (pneumologist), Pr. E. Quoix (pneumologist), Dr. M. Velten (epidemiologist), Pr. D. Wahl (pneumologist), and Pr. M.C. Woronoff-Lemsi (pharmacoeconomist). The authors also thank the following for their contribution for the choice of economic parameters: Dr. M.J. Bismuth, Dr. P. Métral, Pr. C. Quantin, Mrs. M. Vourc’h (Department of medical information-CHU Dijon), Dr. F. Sassi (Department of Social Policy-London School of Economics), Mr. R. Alexandre, Mrs. A. Baron, Dr. M. Bonnans, Mrs. F. Cambecedes, Mrs. N. Carlot, Mrs. N. Jacotot, Dr. M.F. Merentier, Dr. C. Zanni (staff of the Health Insurance of the Counties of Burgundy and Franche-Comté), Pr. J.C. Moisdon (Department of Management-Ecole des Mines-Paris), Dr. S. Limat (Pharmacy Department-Besançon), and Dr. K. Al Zahouri (Department of Epidemiology-Nancy). The research was supported by grants from the Ministry of Health, Urban Community of Nancy, and Lorraine Region.

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  1. Catherine Lejeune

    Present address: Registre Bourguignon des Cancers Digestifs, INSERM EMI 01 06, Faculté de Médecine, BP 87900, 21079, Dijon Cedex, France

Authors and Affiliations

  1. Faculté de Médecine, Dijon, France

    Catherine Lejeune, Patrick Arveux & Christine Binquet

  2. Service Epidémiologie et Evaluation Cliniques, Hôpital Marin, Nancy, France

    Kazem Al Zahouri & Francis Guillemin

  3. Service Pharmacie, Unité Evaluation Médico-économique, Centre Hospitalier Universitaire, Besançon, France

    Marie-Christine Woronoff-Lemsi

  4. Département d’Information Médicale, Centre Georges-François Leclerc, Dijon, France

    Patrick Arveux

  5. Service de Chirurgie Thoracique, Centre Hospitalier Universitaire, Dijon, France

    Alain Bernard

  6. Département d’Information Médicale, Centre Hospitalier Universitaire, Dijon, France

    Christine Binquet

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  1. Catherine Lejeune
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Correspondence to Catherine Lejeune.

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Lejeune, C., Al Zahouri, K., Woronoff-Lemsi, MC. et al. Use of a decision analysis model to assess the medicoeconomic implications of FDG PET imaging in diagnosing a solitary pulmonary nodule. Eur J Health Econ 6, 203–214 (2005). https://doi.org/10.1007/s10198-005-0279-0

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