Cost Effectiveness of Positron Emission Tomography in Patients With Hodgkin’s Lymphoma in Unconfirmed Complete Remission or Partial Remission After First-Line Therapy Juliano J. Cerci, Evelinda Trindade, Luís F. Pracchia, Felipe A. Pitella, Camila C.G. Linardi, Jose ´ Soares Jr, Dominique Delbeke, Leigh-Ann Topfer, Valeria Buccheri, and Jose ´ C. Meneghetti From the Department of Nuclear Medi- cine and Health Technology Assess- ment/Executive Direction, Heart Institute (InCor); Division of Hematol- ogy, Clinical Hospital, University of Sa ˜o Paulo Medical School, Sa ˜ o Paulo, Brazil; Department of Radiology and Radiologi- cal Sciences, Vanderbilt University Medical Center, Nashville, TN; and Research Transition Facility, Health Policy and Management, School of Public Health, University of Edmonton, Alberta, Canada. Submitted August 10, 2009; accepted November 16, 2009; published online ahead of print at www.jco.org on February 8, 2010. Supported by the Brazilian Health Ministry. Authors’ disclosures of potential con- flicts of interest and author contribu- tions are found at the end of this article. Corresponding author: Juliano J. Cerci, MD, Division of Nuclear Medicine, Insti- tuto do Corac ¸a ˜ o da Faculdade de Medi- cina da Universidade de Sa ˜ o Paulo, Avenida Dr Ene ´ as de Carvalho Aguiar, 44, AB, CEP 05403-000, Sa ˜ o Paulo, Brazil; e-mail: cercijuliano@hotmail.com. © 2010 by American Society of Clinical Oncology 0732-183X/10/2808-1415/$20.00 DOI: 10.1200/JCO.2009.25.4367 A B S T R A C T Purpose To assess the cost effectiveness of fluorine-18 –fluorodeoxyglucose positron emission tomogra- phy (FDG-PET) in patients with Hodgkin’s lymphoma (HL) with unconfirmed complete remission (CRu) or partial remission (PR) after first-line treatment. Patients and Methods One hundred thirty patients with HL were prospectively studied. After treatment, all patients with CRu/PR were evaluated with FDG-PET. In addition, PET-negative patients were evaluated with standard follow-up, and PET-positive patients were evaluated with biopsies of the positive lesions. Local unit costs of procedures and tests were evaluated. Cost effectiveness was determined by evaluating projected annual economic impact of strategies without and with FDG-PET on HL management. Results After treatment, CRu/PR was observed in 50 (40.0%) of the 127 patients; the sensitivity, specificity, and positive and negative predictive values of FDG-PET were 100%, 92.0%, 92.3%, and 100%, respectively (accuracy of 95.9%). Local restaging costs without PET were $350,050 compared with $283,262 with PET, a 19% decrease. The incremental cost-effectiveness ratio is -$3,268 to detect one true case. PET costs represented 1% of total costs of HL treatment. Simulated costs in the 974 patients registered in the 2008 Brazilian public health care database showed that the strategy including restaging PET would have a total program cost of $56,498,314, which is $516,942 less than without restaging PET, resulting in a 1% cost saving. Conclusion FDG-PET demonstrated 95.9% accuracy in restaging for patients with HL with CRu/PR after first-line therapy. Given the observed probabilities, FDG-PET is highly cost effective and would reduce costs for the public health care program in Brazil. J Clin Oncol 28:1415-1421. © 2010 by American Society of Clinical Oncology INTRODUCTION New technologic developments and growth in med- ical imaging are challenges for health care providers because they must balance patient care and health care costs. Positron emission tomography (PET) with fluorine-18 –fluorodeoxyglucose (FDG) has been established as a tool for restaging Hodgkin’s lymphomas (HL). 1 Meta-analyses have shown PET to be more accurate than anatomic imaging (com- puted tomography [CT] and magnetic resonance imaging [MRI]) in differentiating viable tumor from benign fibrotic tissue in residual masses af- ter therapy. 2-9 Although the widespread use of PET restaging is a reality in some countries, it is not included as a tool for the evaluation of patients without complete remission in the Brazilian public health system. Clinical observation only for noncomplete respond- ers may lead to disease progression and delay in second-line curative treatment. Early definition of disease activity may be feasible with the use of FDG- PET after treatment. The purpose of this prospective study, sponsored by the Health Ministry of Brazil, is to investigate the health care costs of including FDG- PET imaging in the evaluation of patients with HL with unconfirmed complete remission (CRu) or partial remission (PR) after first-line therapy. JOURNAL OF CLINICAL ONCOLOGY O R I G I N A L R E P O R T VOLUME 28  NUMBER 8  MARCH 10 2010 © 2010 by American Society of Clinical Oncology 1415 Downloaded from ascopubs.org by 3.236.238.35 on June 18, 2022 from 003.236.238.035 Copyright © 2022 American Society of Clinical Oncology. All rights reserved.