Journal of Clinical Oncology, Vol 16, 2113-2125, Copyright © 1998 by American Society of Clinical Oncology

ARTICLES

Analytical decision model for the cost-effective management of solitary pulmonary nodules

SS Gambhir, JE Shepherd, BD Shah, E Hart, CK Hoh, PE Valk, T Emi and ME Phelps
Crump Institute for Biological Imaging, University of California Los Angeles School of Medicine 90095-1770, USA. sgambhir@mednet.ucla.edu

PURPOSE AND METHODS: Multiple strategies are currently being used to manage patients who present with indeterminate solitary pulmonary nodules (SPN). We have used decision-analysis models to assess the cost- effectiveness of various strategies for the diagnosis and management of SPN. Four decision strategies were compared: a wait and watch strategy, a surgery strategy, a computed tomography (CT)-based strategy, and a CT- plus-positron emission tomography (PET) strategy. An incremental cost- effectiveness ratio (ICER) was used to compare all strategies to the wait and watch strategy. RESULTS: A CT-plus-PET strategy was the most cost-effective over a large pretest likelihood (probability of having a malignant nodule), with a range of 0.12 to 0.69. Furthermore, within this likelihood range, the potential cost savings of using the CT-plus- PET strategy over the CT strategy ranged from $91 to $2,200 per patient. This translates to a yearly national savings of approximately $62.7 million. CONCLUSION: Decision-analysis modeling indicates the potential cost-effectiveness of [18F]2-fluoro-2-deoxy-D-glucose (FDG)- PET in the management of SPN. Furthermore, the decision trees developed can be used to model various features of the management of SPN, including modeling the cost-effectiveness of other newly emerging technologies.
CiteULike    Complore    Connotea    Del.icio.us    Digg    Facebook    Reddit    Technorati    Twitter    What's this?

This article has been cited by other articles:

				D. Arenberg PET Scans for Lung Nodules: Costs and Cost-Effectiveness Chest, January 1, 2010; 137(1): 4 - 6. [Full Text] [PDF]

				Y. Ohba, H. Nomori, H. Shibata, H. Kobayashi, T. Mori, S. Shiraishi, and R. Nakashima Evaluation of Semiquantitative Assessments of Fluorodeoxyglucose Uptake on Positron Emission Tomography Scans for the Diagnosis of Pulmonary Malignancies 1 to 3 cm in Size. Ann. Thorac. Surg., March 1, 2009; 87(3): 886 - 891. [Abstract] [Full Text] [PDF]

				B. D. Kozower, B. F. Meyers, C. E. Reed, D. R. Jones, P. A. Decker, and J. B. Putnam Jr Does Positron Emission Tomography Prevent Nontherapeutic Pulmonary Resections for Clinical Stage IA Lung Cancer? Ann. Thorac. Surg., April 1, 2008; 85(4): 1166 - 1170. [Abstract] [Full Text] [PDF]

				E M Schultz, G D Sanders, P R Trotter, E F Patz Jr, G A Silvestri, D K Owens, and M K Gould Validation of two models to estimate the probability of malignancy in patients with solitary pulmonary nodules Thorax, April 1, 2008; 63(4): 335 - 341. [Abstract] [Full Text] [PDF]

				S. K. Kim, M. Allen-Auerbach, J. Goldin, B. J. Fueger, M. Dahlbom, M. Brown, J. Czernin, and C. Schiepers Accuracy of PET/CT in Characterization of Solitary Pulmonary Lesions J. Nucl. Med., February 1, 2007; 48(2): 214 - 220. [Abstract] [Full Text] [PDF]

				K. Awai, K. Murao, A. Ozawa, Y. Nakayama, T. Nakaura, D. Liu, K. Kawanaka, Y. Funama, S. Morishita, and Y. Yamashita Pulmonary Nodules: Estimation of Malignancy at Thin-Section Helical CT--Effect of Computer-aided Diagnosis on Performance of Radiologists Radiology, April 1, 2006; 239(1): 276 - 284. [Abstract] [Full Text] [PDF]

				S. Sachs and T. V. Bilfinger The Impact of Positron Emission Tomography on Clinical Decision Making in a University-Based Multidisciplinary Lung Cancer Practice Chest, August 1, 2005; 128(2): 698 - 703. [Abstract] [Full Text] [PDF]

				H. Nomori, K. Watanabe, T. Ohtsuka, T. Naruke, K. Suemasu, and K. Uno Visual and Semiquantitative Analyses for F-18 Fluorodeoxyglucose PET Scanning in Pulmonary Nodules 1 cm to 3 cm in Size Ann. Thorac. Surg., March 1, 2005; 79(3): 984 - 988. [Abstract] [Full Text] [PDF]

				B. Davies, S. Ghosh, D. Hopkinson, R. Vaughan, and G. Rocco Solitary pulmonary nodules: pathological outcome of 150 consecutively resected lesions Interactive CardioVascular and Thoracic Surgery, February 1, 2005; 4(1): 18 - 20. [Abstract] [Full Text] [PDF]

				C. C. Earle Outcomes Research in Lung Cancer J Natl Cancer Inst Monographs, October 1, 2004; 2004(33): 56 - 77. [Abstract] [Full Text] [PDF]

				P. S. Oturai, J. Mortensen, H. Enevoldsen, A. Eigtved, V. Backer, K. P. Olesen, H. W. Nielsen, H. Hansen, P. Stentoft, and L. Friberg {gamma}-Camera 18F-FDG PET in Diagnosis and Staging of Patients Presenting with Suspected Lung Cancer and Comparison with Dedicated PET J. Nucl. Med., August 1, 2004; 45(8): 1351 - 1357. [Abstract] [Full Text] [PDF]

				M. Berger, M. K. Gould, and P. G. Barnett The Cost of Positron Emission Tomography in Six United States Veterans Affairs Hospitals and Two Academic Medical Centers Am. J. Roentgenol., August 1, 2003; 181(2): 359 - 365. [Abstract] [Full Text] [PDF]

				D. Ost, A. M. Fein, and S. H. Feinsilver The Solitary Pulmonary Nodule N. Engl. J. Med., June 19, 2003; 348(25): 2535 - 2542. [Full Text] [PDF]

				M. K. Gould, G. D. Sanders, P. G. Barnett, C. E. Rydzak, C. C. Maclean, M. B. McClellan, and D. K. Owens Cost-Effectiveness of Alternative Management Strategies for Patients with Solitary Pulmonary Nodules Ann Intern Med, May 6, 2003; 138(9): 724 - 735. [Abstract] [Full Text] [PDF]

				H. Stevens, P. F.A. Bakker, N. J.J. Schlosser, P. P. van Rijk, and J. M.H. de Klerk Use of a Dual-Head Coincidence Camera and 18F-FDG for Detection and Nodal Staging of Non-Small Cell Lung Cancer: Accuracy as Determined by 2 Independent Observers J. Nucl. Med., March 1, 2003; 44(3): 336 - 340. [Abstract] [Full Text] [PDF]

				M N Maisey Overview of clinical PET Br. J. Radiol., November 1, 2002; 75(90009): S1 - 5. [Full Text] [PDF]

				E. M. Marom, S. Sarvis, J. E. Herndon, and E. F. Patz Jr T1 Lung Cancers: Sensitivity of Diagnosis with Fluorodeoxyglucose PET Radiology, May 1, 2002; 223(2): 453 - 459. [Abstract] [Full Text] [PDF]

				N. Hollings and P. Shaw Diagnostic imaging of lung cancer Eur. Respir. J., April 1, 2002; 19(4): 722 - 742. [Abstract] [Full Text] [PDF]

				H. A. Nabi and J. M. Zubeldia Clinical Applications of 18F-FDG in Oncology J. Nucl. Med. Technol., March 1, 2002; 30(1): 3 - 9. [Abstract] [Full Text] [PDF]

				S F Barrington Whole body applications of positron emission tomography in oncology Imaging, September 1, 2001; 13(3): 185 - 196. [Abstract] [Full Text] [PDF]

				G. W. Frank, A. M. Fein, and D. E. Ost COMPLICATIONS OF EVALUATING NODULES Am. J. Respir. Crit. Care Med., June 1, 2001; 163(7): 1757 - 1758. [Full Text] [PDF]

				G J R Cook The clinical use of PET--where are we now? Br. J. Radiol., May 1, 2001; 74(881): 399 - 401. [Full Text] [PDF]

				J.F. Vansteenkiste and S.G. Stroobants The role of positron emission tomography with 18F-fluoro-2-deoxy-D-glucose in respiratory oncology Eur. Respir. J., April 1, 2001; 17(4): 802 - 820. [Abstract] [Full Text] [PDF]

				J. Meta, M. Seltzer, C. Schiepers, D. H. Silverman, M. Ariannejad, S. S. Gambhir, M. E. Phelps, P. Valk, and J. Czernin Impact of 18F-FDG PET on Managing Patients with Colorectal Cancer: The Referring Physician's Perspective J. Nucl. Med., April 1, 2001; 42(4): 586 - 590. [Abstract] [Full Text]

				D. OST and A. FEIN Evaluation and Management of the Solitary Pulmonary Nodule Am. J. Respir. Crit. Care Med., September 1, 2000; 162(3): 782 - 787. [Full Text]

				E. F. Patz Jr 1999 Plenary Session: Friday Imaging Symposium : Evaluation of Focal Pulmonary Abnormalities with FDG PET RadioGraphics, July 1, 2000; 20(4): 1182 - 1185. [Full Text] [PDF]

				W. J. Scott, J. Shepherd, and S. S. Gambhir Cost-effectiveness of FDG-PET for staging non-small cell lung cancer: a decision analysis Ann. Thorac. Surg., December 1, 1998; 66(6): 1876 - 1883. [Abstract] [Full Text] [PDF]