Impact of (18F)FDG-PET/CT and Laparoscopy in Staging of Locally Advanced Gastric Cancer: A Cost Analysis in the Prospective Multicenter PLASTIC-Study
Publication year
2024Author(s)
Source
Annals of Surgical Oncology, 31, 6, (2024), pp. 4005-4017ISSN
Publication type
Article / Letter to editor
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Organization
Gastroenterology
Journal title
Annals of Surgical Oncology
Volume
vol. 31
Issue
iss. 6
Page start
p. 4005
Page end
p. 4017
Subject
Gastroenterology - Radboud University Medical CenterAbstract
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.
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- Academic publications [245284]
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- Faculty of Medical Sciences [93207]
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