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Assessing short-term effects and costs at an early stage of innovation: The use of positron emission tomography on radiotherapy treatment decision making

Published online by Cambridge University Press:  09 April 2008

Raphaël Remonnay ,
Magali Morelle ,
Pascal Pommier ,
Francesco Giammarile  and
Marie-Odile Carrère
Raphaël Remonnay
Affiliation:
GATE CNRS-UMR 5824 and Centre Léon Bérard
Magali Morelle
Affiliation:
GATE CNRS-UMR 5824 and Centre Léon Bérard
Pascal Pommier
Affiliation:
Regional Cancer Center Léon Bérard
Francesco Giammarile
Affiliation:
University of Lyon and Centre Hospitalier Lyon-Sud
Marie-Odile Carrère
Affiliation:
GATE CNRS-UMR 5824
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Abstract

Objectives: Positron emission tomography (PET) is an innovative imaging tool. Associated with computed tomography (CT), it allows a better definition for the tumor volume for radiotherapy, compared with CT only. The aim of this study was to assess the effects of PET on resource allocation (costs and savings) and on the choice of the following treatment in radiotherapy.

Methods: In 2004 and 2005, 209 patients were enrolled (97 patients with Hodgkin's disease and 112 with non-small cell lung cancer) in a national study conducted in eight hospitals. Two treatment decisions made on the basis of CT only or CT associated with PET, were compared in a prospective study where each subject was his/her own control. The direct medical cost of using PET was assessed by microcosting, using data collected from specific questionnaires. The costs of new tests and the costs and savings associated with changes in the chosen treatment were calculated on the basis of reimbursement rates.

Results: The mean cost of using PET was approximately €800 per patient (50 percent for the radionuclide 18F-FDG [2-[18F]fluoro-2-deoxy-D-glucose]). Radiotherapy treatments were modified for 10 percent of patients with Hodgkin's disease versus 40 percent of patients with lung cancer. Overall, the use of PET induced both increases and decreases in the mean cost per patient: the net effect was a €425 and €931 cost increase in lung cancer and Hodgkin's disease, respectively.

Conclusions: The use of PET for radiotherapy decision making seems more valuable for lung cancer than for Hodgkin's disease, both in terms of costs and changes in radiotherapy treatment. This result might help policy makers for prioritization.

Keywords

Cost evaluationPETRadiotherapyHodgkin's diseaseNon-small-cell lung cancer
Type
GENERAL ESSAYS
Information
International Journal of Technology Assessment in Health Care , Volume 24 , Issue 2 , April 2008 , pp. 212 - 220
Copyright
Copyright © Cambridge University Press 2008

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