Impact of 18F FDG-PET/CT and Laparoscopy in Staging of Locally Advanced Gastric Cancer: A Cost Analysis in the Prospective Multicenter PLASTIC-Study.

Autor: de Jongh C; Department of Surgery, Medical Oncology and Radiology, University Medical Center (UMC) Utrecht, Utrecht, The Netherlands., van der Meulen MP; Julius Center for Health Sciences and Primary Care, UMC Utrecht, Utrecht, The Netherlands., Gertsen EC; Department of Surgery, Medical Oncology and Radiology, University Medical Center (UMC) Utrecht, Utrecht, The Netherlands., Brenkman HJF; Department of Surgery, Medical Oncology and Radiology, University Medical Center (UMC) Utrecht, Utrecht, The Netherlands., van Sandick JW; Surgery and Nuclear Medicine Department, The Netherlands Cancer Institute-Antoni van Leeuwenhoek, Amsterdam, The Netherlands., van Berge Henegouwen MI; Surgery Department, Amsterdam UMC, Location University of Amsterdam, Amsterdam, The Netherlands.; Surgery and Pathology Department, Cancer Center Amsterdam, Amsterdam, The Netherlands., Gisbertz SS; Surgery Department, Amsterdam UMC, Location University of Amsterdam, Amsterdam, The Netherlands.; Surgery and Pathology Department, Cancer Center Amsterdam, Amsterdam, The Netherlands., Luyer MDP; Surgery Department, Catharina Hospital Eindhoven, Eindhoven, The Netherlands., Nieuwenhuijzen GAP; Surgery Department, Catharina Hospital Eindhoven, Eindhoven, The Netherlands., van Lanschot JJB; Surgery and Nuclear Medicine Department, Erasmus Medical Center UMC Rotterdam, Rotterdam, The Netherlands., Lagarde SM; Surgery and Nuclear Medicine Department, Erasmus Medical Center UMC Rotterdam, Rotterdam, The Netherlands., Wijnhoven BPL; Surgery and Nuclear Medicine Department, Erasmus Medical Center UMC Rotterdam, Rotterdam, The Netherlands., de Steur WO; Surgery Department, Leiden UMC, Leiden, The Netherlands., Hartgrink HH; Surgery Department, Leiden UMC, Leiden, The Netherlands., Stoot JHMB; Surgery Department, Zuyderland MC, Sittard-Geleen, The Netherlands., Hulsewe KWE; Surgery Department, Zuyderland MC, Sittard-Geleen, The Netherlands., Spillenaar Bilgen EJ; Surgery Department, Rijnstate Hospital, Arnhem, the Netherlands., van Det MJ; Surgery Department, ZGT Hospital, Almelo, The Netherlands., Kouwenhoven EA; Surgery Department, ZGT Hospital, Almelo, The Netherlands., Daams F; Surgery and Pathology Department, Cancer Center Amsterdam, Amsterdam, The Netherlands.; Surgery and Pathology Department, Location Vrije University, Amsterdam UMC, Amsterdam, The Netherlands., van der Peet DL; Surgery and Pathology Department, Cancer Center Amsterdam, Amsterdam, The Netherlands.; Surgery and Pathology Department, Location Vrije University, Amsterdam UMC, Amsterdam, The Netherlands., van Grieken NCT; Surgery and Pathology Department, Cancer Center Amsterdam, Amsterdam, The Netherlands.; Surgery and Pathology Department, Location Vrije University, Amsterdam UMC, Amsterdam, The Netherlands., Heisterkamp J; Surgery Department, Elisabeth Twee-Steden Hospital, Tilburg, The Netherlands., van Etten B; Surgery Department, UMC Groningen, Groningen, The Netherlands., van den Berg JW; Surgery Department, UMC Groningen, Groningen, The Netherlands., Pierie JP; Surgery Department, Medical Center Leeuwarden, Leeuwarden, The Netherlands., Eker HH; Surgery Department, Medical Center Leeuwarden, Leeuwarden, The Netherlands., Thijssen AY; Gastroenterology Department, Albert Schweitzer Hospital, Dordrecht, The Netherlands., Belt EJT; Gastroenterology Department, Albert Schweitzer Hospital, Dordrecht, The Netherlands., van Duijvendijk P; Surgery Department, Gelre Hospitals, Apeldoorn, The Netherlands., Wassenaar E; Surgery Department, Gelre Hospitals, Apeldoorn, The Netherlands., Wevers KP; Surgery Department, Isala Hospital, Zwolle, The Netherlands., Hol L; Gastroenterology Department, Maasstad Hospital, Rotterdam, The Netherlands., Wessels FJ; Department of Surgery, Medical Oncology and Radiology, University Medical Center (UMC) Utrecht, Utrecht, The Netherlands., Haj Mohammad N; Department of Surgery, Medical Oncology and Radiology, University Medical Center (UMC) Utrecht, Utrecht, The Netherlands., Frederix GWJ; Julius Center for Health Sciences and Primary Care, UMC Utrecht, Utrecht, The Netherlands., van Hillegersberg R; Department of Surgery, Medical Oncology and Radiology, University Medical Center (UMC) Utrecht, Utrecht, The Netherlands., Siersema PD; Gastroenterology and Hepatology Department, Erasmus MC - University Medical Center, Rotterdam, Rotterdam, The Netherlands., Vegt E; Surgery and Nuclear Medicine Department, The Netherlands Cancer Institute-Antoni van Leeuwenhoek, Amsterdam, The Netherlands.; Surgery and Nuclear Medicine Department, Erasmus Medical Center UMC Rotterdam, Rotterdam, The Netherlands., Ruurda JP; Department of Surgery, Medical Oncology and Radiology, University Medical Center (UMC) Utrecht, Utrecht, The Netherlands. J.P.Ruurda@umcutrecht.nl.
Jazyk: angličtina
Zdroj: Annals of surgical oncology [Ann Surg Oncol] 2024 Jun; Vol. 31 (6), pp. 4005-4017. Date of Electronic Publication: 2024 Mar 25.
DOI: 10.1245/s10434-024-15103-4
Abstrakt: 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.
(© 2024. The Author(s).)
Databáze: MEDLINE
Externí odkaz: