A systematic review of PET and PET/CT in oncology: A way to personalize cancer treatment in a cost-effective manner?

Background: A number of diagnostic tests are required for the
detection and management of cancer. Most imaging modalities such as
computerized tomography (CT) are anatomical. However, positron
emission tomography (PET) is a functional diagnostic imaging
technique using compounds labelled with positron-emitting
radioisotopes to measure cell metabolism. It has been a useful tool
in studying soft tissues such as the brain, cardiovascular system,
and cancer. The aim of this systematic review is to critically
summarize the health economic evidence of oncologic PET in the
literature. Methods: Eight electronic databases were searched from
2005 until February 2010 to identify economic evaluation studies
not included in previous Health Technology Assessment (HTA)
reports. Only full health economic evaluations in English, French,
or German were considered for inclusion. Economic evaluations were
appraised using published quality criteria for assessing the
quality of decision analytic models. Given the variety of methods
used in the health economic evaluations, the economic evidence has
been summarized in qualitative form. Results: From this new search,
14 publications were identified that met the inclusion criteria.
All publications were decision analytic models and evaluated PET
using Fluorodeoxyglucose F18 (FDG-PET). Eight publications were
cost-effectiveness analyses; six were cost-utility analyses. The
studies were from Australia, Belgium, Canada, France, Italy,
Taiwan, Japan, the Netherlands, the United Kingdom, and the United
States. In the base case analyses of these studies,
cost-effectiveness results ranged from dominated to dominant. The
methodology of the economic evaluations was of varying quality.
Cost-effectiveness was primarily influenced by the cost of PET, the
specificity of PET, and the risk of malignancy. Conclusions: Owing
to improved care and less exposure to ineffective treatments,
personalized medicine using PET may be cost-effective. However, the
strongest evidence for the cost-effectiveness of PET is still in
the staging of non-small cell lung cancer. Management decisions
relating to the assessment of treatment response or radiotherapy
treatment planning require further research to show the impact of
PET on patient management and its cost-effectiveness. Because of
the potential for increased patient throughput and the possible
greater accuracy, the cost-effectiveness of PET/CT may be superior
to that of PET. Only four studies of the cost-effectiveness of
PET/CT were found in this review, and this is clearly an area for
future research.