Solitary pulmonary nodules: accuracy and cost-effectiveness of sodium iodide FDG-PET using Australian data

• Published in: European journal of nuclear medicine and molecular imaging 2002-08, Vol.29 (8), p.1016-1023
• Main Authors: KEITH, C. J, MILES, K. A, GRIFFITHS, M. R, WONG, D, PITMAN, A. G, HICKS, R. J
• Format: Article
• Language: English
• Subjects: Aged; Australia; Biological and medical sciences; Cohort Studies; Cost Savings; Cost-Benefit Analysis - methods; Decision Trees; Female; Fluorodeoxyglucose F18 - economics; Humans; Investigative techniques, diagnostic techniques (general aspects); Lung Neoplasms - diagnosis; Lung Neoplasms - economics; Male; Medical sciences; Middle Aged; Pneumology; Radionuclide investigations; Radiopharmaceuticals - economics; Respiratory system; Retrospective Studies; Sensitivity and Specificity; Solitary Pulmonary Nodule - diagnosis; Solitary Pulmonary Nodule - diagnostic imaging; Solitary Pulmonary Nodule - economics; Tomography, Emission-Computed - economics; Tumors of the respiratory system and mediastinum
• ISSN: 1619-7070; 1619-7089
• DOI: 10.1007/s00259-002-0833-2

This study uses Australian data to confirm the accuracy of dedicated sodium iodide (NaI) fluorine-18 fluorodeoxyglucose positron emission tomography (FDG-PET) in evaluating indeterminate solitary pulmonary nodules (SPNs) and to determine the conditions under which PET could play a cost-effective role in this evaluation. Ninety-two patients from two Australian hospitals in different states underwent FDG-PET for evaluation of an SPN. Observed values for prior probability of malignancy and diagnostic accuracy of PET were applied to previously published decision tree models using published Australian health care costs. The accuracy of FDG-PET was 93% with a sensitivity of 92% and a specificity of 95%. The prior probability of malignancy (0.54), PET sensitivity and PET specificity indicated cost savings per patient of up to EUR 455 (Adollars 774) based on a PET cost of EUR 706 (Adollars 1,200). PET would remain cost-effective for levels of prior probability up to 0.8-0.9 and a PET cost of EUR 736-1,161 (Adollars 1,252-Adollars 1,974). It is concluded that NaI PET is accurate, cost saving and cost-effective for the characterisation of indeterminate pulmonary nodules in Australia. Comparison with previous reports from the United States confirms that FDG-PET can remain cost-effective despite population differences in medical costs, disease prevalence and PET diagnostic performance.