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. 2022 Apr;63(4):543-548.
doi: 10.2967/jnumed.121.262324. Epub 2021 Aug 19.

PET-Based Staging Is Cost-Effective in Early-Stage Follicular Lymphoma

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PET-Based Staging Is Cost-Effective in Early-Stage Follicular Lymphoma

Andrea C Lo et al. J Nucl Med. 2022 Apr.

Abstract

The objective was to assess the cost-effectiveness of staging PET/CT in early-stage follicular lymphoma (FL) from the Canadian health-care system perspective. Methods: The study population was FL patients staged as early-stage using conventional CT imaging and planned for curative-intent radiation therapy (RT). A decision analytic model simulated the management after adding staging PET/CT versus using staging CT alone. In the no-PET/CT strategy, all patients proceeded to curative-intent RT as planned. In the PET/CT strategy, PET/CT information could result in an increased RT volume, switching to a noncurative approach, or no change in RT treatment as planned. The subsequent disease course was described using a state-transition cohort model over a 30-y time horizon. Diagnostic characteristics, probabilities, utilities, and costs were derived from the literature. Baseline analysis was performed using quality-adjusted life years (QALYs), costs (2019 Canadian dollars), and the incremental cost-effectiveness ratio. Deterministic sensitivity analyses were conducted, evaluating net monetary benefit at a willingness-to-pay threshold of $100,000/QALY. Probabilistic sensitivity analysis using 10,000 simulations was performed. Costs and QALYs were discounted at a rate of 1.5%. Results: In the reference case scenario, staging PET/CT was the dominant strategy, resulting in an average lifetime cost saving of $3,165 and a gain of 0.32 QALYs. In deterministic sensitivity analyses, the PET/CT strategy remained the preferred strategy for all scenarios supported by available data. In probabilistic sensitivity analysis, the PET/CT strategy was strongly dominant in 77% of simulations (i.e., reduced cost and increased QALYs) and was cost-effective in 89% of simulations (i.e., either saved costs or had an incremental cost-effectiveness ratio below $100,000/QALY). Conclusion: Our analysis showed that the use of PET/CT to stage early-stage FL patients reduces cost and improves QALYs. Patients with early-stage FL should undergo PET/CT before curative-intent RT.

Keywords: PET/CT; cost-effectiveness analysis; follicular lymphoma; radiation therapy; staging.

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Figures

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Graphical abstract
FIGURE 1.
FIGURE 1.
Decision tree depicting management after staging PET/CT vs. no staging PET/CT. M = state-transition cohort model.
FIGURE 2.
FIGURE 2.
Simplified state-transition cohort model (dotted arrows represent transition to next state after relapse or progression; solid arrows represent transition to next state without relapse or progression.

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