학술논문
Impact of 18F FDG-PET/CT and Laparoscopy in Staging of Locally Advanced Gastric Cancer: A Cost Analysis in the Prospective Multicenter PLASTIC-Study
Document Type
Original Paper
Author
de Jongh, Cas; van der Meulen, Miriam P.; Gertsen, Emma C.; Brenkman, Hylke J. F.; van Sandick, Johanna W.; van Berge Henegouwen, Mark I.; Gisbertz, Suzanne S.; Luyer, Misha D. P.; Nieuwenhuijzen, Grard A. P.; van Lanschot, Jan J. B.; Lagarde, Sjoerd M.; Wijnhoven, Bas P. L.; de Steur, Wobbe O.; Hartgrink, Henk H.; Stoot, Jan H. M. B.; Hulsewe, Karel W. E.; Spillenaar Bilgen, Ernst Jan; van Det, Marc J.; Kouwenhoven, Ewout A.; Daams, Freek; van der Peet, Donald L.; van Grieken, Nicole C. T.; Heisterkamp, Joos; van Etten, Boudewijn; van den Berg, Jan-Willem; Pierie, Jean-Pierre; Eker, Hasan H.; Thijssen, Annemieke Y.; Belt, Eric J. T.; van Duijvendijk, Peter; Wassenaar, Eelco; Wevers, Kevin P.; Hol, Lieke; Wessels, Frank J.; Haj Mohammad, Nadia; Frederix, Geert W. J.; van Hillegersberg, Richard; Siersema, Peter D.; Vegt, Erik; Ruurda, Jelle P.
Source
Annals of Surgical Oncology. 31(6):4005-4017
Subject
Language
English
ISSN
1068-9265
1534-4681
1534-4681
Abstract
Background: Unnecessary D2-gastrectomy and associated costs can be prevented after detecting non-curable gastric cancer, but impact of staging on treatment costs is unclear. This study determined the cost impact of 18 F-fluorodeoxyglucose positron emission tomography/computed tomography (18F FDG-PET/CT) and staging laparoscopy (SL) in gastric cancer staging.Materials and Methods: In this cost analysis, four staging strategies were modeled in a decision tree: (1) 18F FDG-PET/CT first, then SL, (2) SL only, (3) 18F FDG-PET/CT only, and (4) neither SL nor 18F FDG-PET/CT. Costs were assessed on the basis of the prospective PLASTIC-study, which evaluated adding 18F FDG-PET/CT and SL to staging advanced gastric cancer (cT3–4 and/or cN+) in 18 Dutch hospitals. The Dutch Healthcare Authority provided 18F FDG-PET/CT unit costs. SL unit costs were calculated bottom-up. Gastrectomy-associated costs were collected with hospital claim data until 30 days postoperatively. Uncertainty was assessed in a probabilistic sensitivity analysis (1000 iterations).Results: 18F FDG-PET/CT costs were €1104 including biopsy/cytology. Bottom-up calculations totaled €1537 per SL. D2-gastrectomy costs were €19,308. Total costs per patient were €18,137 for strategy 1, €17,079 for strategy 2, and €19,805 for strategy 3. If all patients undergo gastrectomy, total costs were €18,959 per patient (strategy 4). Performing SL only reduced costs by €1880 per patient. Adding 18F FDG-PET/CT to SL increased costs by €1058 per patient; IQR €870–1253 in the sensitivity analysis.Conclusions: For advanced gastric cancer, performing SL resulted in substantial cost savings by reducing unnecessary gastrectomies. In contrast, routine 18F FDG-PET/CT increased costs without substantially reducing unnecessary gastrectomies, and is not recommended due to limited impact with major costs.Trial registration: NCT03208621. This trial was registered prospectively on 30-06-2017.