Table 3.
Overview of economic studies included in two previous HTAs
| Author, year, country | Study population* | Comparison alternatives | Perspective/type of study | Results and unit* | Economic evidence |
|---|---|---|---|---|---|
| Recurrence of colorectal cancer | |||||
| Park et al. 2001, USA [95] | Patients with an increase in carcinoembryonic antigen levels of > 5 ng/ml during follow-up testing after the resection of their primary CRC | CT+PET versus CT | Public payer (Medicare)/CEA using a model approach (decision tree) | ICER (US$/LYG): 16,437 | Fairb |
| Sloka et al. 2004, Canada [96] | 65-year-old patient presenting with suspected recurrent CRC | CT+PET versus CT | Hospital/CEA using a model approach (decision tree) | Cost savings: C$1,758a | Fairb |
| Staging of head and neck cancer | |||||
| Hollenbeak et al. 2001, USA [97] | HNSCC patients with no evidence of lymph node involvement | CT+PET versus CT | Hospital/CEA/CUA using a model approach (decision tree) | ICER (US$/LYG (US$/QALY)): 8,718 (2,505) | Fairb |
| Restaging of malignant lymphoma | |||||
| Bradbury et al. 2002, UK [29] | HD patients who have achieved a partial or complete response to induction therapy | (1) All for surveillance; (2) All for consolidation; (3) CT; (4) PET after positive CT; (5) (CT)+PET | Health care system/CUA using a model approach (decision model with two components: decision tree and Markov model) | Strategies 4 and 5 were found to be cost-effective, provided WTP exceeds £1000/LYG, and for almost all input values considered, provided WTP exceeds £5000/LYG | Goodb |
| Diagnosis of solitary pulmonary nodules | |||||
| Dietlein et al. 2000, Germany [98] | 62-year-old man with a SPN of up to 3 cm without calcification, specula and enlargement of mediastinal lymph nodes | (1) WW; (2) TNB; (3) Exploratory surgery; (4) PET | Public insurer/CEA using a model approach (decision tree) | Best ICER (€/LYG): 3,218 (4 versus 1); the exploratory surgery strategy was found to be dominated by PET | Goodb, c |
| Gambhir et al. 1998, USA [99] | 64-year-old white man (1.5 packs/day smoker) with a 2.5-cm nodule | (1) WW (baseline strategy); (2) Thoracotomy; (3) CT; (4) CT+PET | Public payer (Medicare)/CEA using a model approach (decision tree) | Best ICER (US$/LYG): 3,266 for CT | Goodb, c |
| Gould et al. 2003, USA [100] | 62-year-old patient with a new, non-calcified pulmonary nodule seen on chest radiograph | 40 clinically plausible sequences of five diagnostic technologies: CT, PET, TNB, surgery, and WW (baseline strategy) | Societal/CUA using a model approach (Markov model) | Best ICER (US$/QALY): 10,935 for strategy 7 (CT: if results indeterminate, biopsy; if results benign, WW)/7,625 for strategy 7/6,515 for CT (if results indeterminate, surgery; if results benign, WW)** | Goodb |
| Staging of non-small cell lung cancer | |||||
| Bradbury et al. 2002, UK [29] | Medically fit for either surgery or non-surgical treatment, 62-year-old patient | (1) All for surgery; (2) All for non-surgical treatment; (3) MS; (4) PET after negative MS; (5) PET; (6) MS after negative PET; (7) MS after positive PET (no N0/1 M1 disease) | Health care system/CUA using a model approach (decision tree) | Best ICER (£/QALY): 58,951 for CT-positive patients (7 versus 3); 10,475 for CT-negative patients (7 versus 1) | Goodb |
| Dietlein et al. 2000, Germany [31] | 62-year-old man with histologically established and assessed as locally resectable NSCLC without distant metastases | (1) Conventional staging; (2) PET in patients with normal-sized lymph nodes; (3) PET for all; (4) PET without supplementary MS if positive CT and PET; (5) PET without supplementary MS if positive PET | Public insurer/CEA using a model approach (decision tree) | Best ICER (€/LYG): 143 (2 versus 1); 15,325 (4 versus 2); 17,438 (5 versus 3) | Goodb |
| Dussault et al. 2001, Canada [101] | 65-year-old male with histologically confirmed NSCLC without mediastinal and distant metastases | CT+PET versus CT | Health care system/CEA using a model approach (decision tree) | ICER (C$/LYG): 4,689 | Goodb |
| Kosuda et al. 2000, Japan [102] | Patient with suspected NSCLC, stage IIIB or less | CT+PET versus CT | Hospital/CEA using a model approach (decision tree) | ICER (¥/LYG): 218,000 | Goodb, c |
| Scott et al. 1998, USA [30] | 64-year-old male with NSCLC | (1) CT (MS after positive CT); (2) PET after negative CT (MS after positive CT); (3) CT+PET (MS after positive PET); (4) CT+PET (MS after positive CT or positive PET after negative CT) | Public payer (Medicare)/CEA using a model approach (decision tree) | Best ICER (US$/LYG): 25,286 (2 versus 1) | Goodc |
| Sloka et al. 2004, Canada [103] | 65-year-old patient with suspected NSCLC | CT+PET versus CT | Health care system/CEA using a model approach (decision tree) | Cost-savings: C$1,455a | Goodb |
aICER not calculated on account of the clinical insignificance of the outcome difference in terms of life expectancy; bStudy quality was assessed by Cleemput et al. [6] using the Drummond, Jefferson checklist [9]; cStudy quality was assessed by Müller et al. [7] using a standardized transparency and quality catalogue [104]; *Base case; **Low/intermediate/high probability of malignancy respectively; CRC: colorectal cancer, CEA: cost-effectiveness analysis, CT: computerized tomography, CUA: cost-utility analysis, HD: Hodgkin's disease, HNSCC: head and neck squamous cell carcinoma, ICER: incremental cost-effectiveness ratio, LYG: life-year gained, MS: mediastinoscopy, ng/ml: nanograms per millilitre, NSCLC: non-small cell lung cancer, PET: positron emission tomography, QALY: quality-adjusted life-year, SPN: solitary pulmonary nodule, TNB: transthoracic needle biopsy, UK: United Kingdom, USA: United States of America, WTP: willingness to pay, WW: wait and watch.