Using Cost-Effectiveness Evidence to Support Use of Existing Positron-Emission Tomography Technology As Diagnostic Tool for High-Risk Cancer Patients

OBJECTIVES: In Australia, 18F-fluorodeoxyglucose positron-emission tomography with low dose computed tomography (FDG-PET/CT) is currently only funded for cancer staging-related indications. A recent multicenter randomized trial demonstrated FDG-PET/CT, compared to standard of care computed tomography (CT) imaging, positively impacted antimicrobial management and outcomes of patients with persistent and recurrent neutropenic fever. There is potential value in expanding the use of FDG-PET/CT as a diagnostic tool. We conducted an economic evaluation from a healthcare perspective alongside the clinical trial comparing between the FDG-PET/CT group and standard CT group.

METHODS: Case report forms were used to collect resource utilization data and hospitalization duration. Effectiveness was measured as number of patients with antimicrobial rationalization and quality-adjusted life years (QALYs) derived from patient-reported trial-based health-related quality-of-life. Generalized linear models (GLM) were used to analyze costs and outcomes. Incremental cost-effectiveness ratios (ICERs) for each of the outcomes were calculated and ICERs interpreted as the cost per patient with antimicrobial rationalization and cost per QALY gained. We performed bootstrapping with 1000 replications using the recycled predictions method.

RESULTS: The adjusted health care costs were lower in the FDG-PET/CT group (mean $49,563; 95%CI 36,867,65,133) compared to the standard CT group (mean $57,574; 95% CI 44,837,73,347). The magnitude of differences in QALYs between the two groups was small (0.001; 95% CI -0.001,-0.001). When simulated 1000 times, our analysis showed that across both outcomes FDG-PET/CT was the dominant strategy as was cheaper and had better outcomes than the standard CT group in 74% of simulations.

CONCLUSIONS: FDG-PET/CT is cost effective when compared to standard of care CT for investigation of persistent/recurrent neutropenic fever in high-risk patients. Aligning economic evaluation alongside the clinical study is key to an integrated evidence generation approach to further support funding for this investigation for this indication.