Cost-effectiveness of positron emission tomography in recurrent colorectal cancer in Canada

Abstract

BACKGROUND: Several studies over the past decade have demonstrated that 2-fluoro-2-D-[18F]fluorodeoxyglucose (FDG) positron emission tomography (PET) is more accurate than computed tomography (CT) for the staging of recurrent colorectal carcinoma. This study uses quantitative decision tree modeling and sensitivity analysis to assess the cost-effectiveness of a PET-based management strategy for staging recurrent colorectal carcinoma in Canada. Both management costs and life expectancy are determined. METHODS: Two patient management strategies were compared - one using CT alone and one using both CT and PET. A survey of recent literature was used to construct a meta-analyses of available studies for the accuracy of PET in staging recurrent colorectal carcinoma. Life expectancies were determined from recent Canadian statistics, and expected life expectancies with disease were calculated from published survival rates. Management costs were determined from: estimates of the installation cost of PET facilities in Canada; management costs from our institutions; and recently published Canadian cost estimates of various procedures. RESULTS: A cost savings of $1,758 per person is expected for a PET and CT strategy, along with a slight increase in life expectancy (3.8 days), when compared with a CT alone strategy. This cost savings stemmed from avoided surgeries and remained in favour of the PET strategy when subjected to a rigorous sensitivity analysis.