Impact of 18FFDG-PET/CT and Laparoscopy in Staging of Locally Advanced Gastric Cancer: A Cost Analysis in the Prospective Multicenter PLASTIC-Study.
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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, PLASTIC Study Group
Аннотация
MATERIALS AND METHODS: In this cost analysis, four staging strategies were modeled in a decision tree: (1) 18FFDG-PET/CT first, then SL, (2) SL only, (3) 18FFDG-PET/CT only, and (4) neither SL nor 18FFDG-PET/CT. Costs were assessed on the basis of the prospective PLASTIC-study, which evaluated adding 18FFDG-PET/CT and SL to staging advanced gastric cancer (cT3-4 and/or cN+) in 18 Dutch hospitals. The Dutch Healthcare Authority provided 18FFDG-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: 18FFDG-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 18FFDG-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 18FFDG-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.