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

de Jongh, Cas; van der Meulen, Miriam; Gertsen, Emma; Brenkman, Hylke; van Sandick, Johanna; van Berge Henegouwen, Mark; Gisbertz, Suzanne; Luyer, Misha; Nieuwenhuijzen, Grard; van Lanschot, Jan; Lagarde, Sjoerd; Wijnhoven, Bas; de Steur, Wobbe; Hartgrink, Henk; Stoot, Jan; Hulsewe, Karel; Spillenaar Bilgen, Ernst; van Det, Marc; Kouwenhoven, Ewout; Daams, Freek; van der Peet, Donald; van Grieken, Nicole; Heisterkamp, Joos; van Etten, Boudewijn; van den Berg, Jan-Willem; Pierie, Jean-Pierre; EKER, Hasan; Thijssen, Annemieke; Belt, Eric; van Duijvendijk, Peter; Wassenaar, Eelco; Wevers, Kevin; Hol, Lieke; Wessels, Frank; Haj Mohammad, Nadia; Frederix, Geert; van Hillegersberg, Richard; Siersema, Peter; Vegt, Erik; Ruurda, Jelle

doi:10.1245/s10434-024-15103-4

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

de Jongh C., van der Meulen M. P., Gertsen E. C., Brenkman H. J. F., van Sandick J. W., van Berge Henegouwen M. I., ...Daha Fazla

Annals of Surgical Oncology, cilt.31, sa.6, ss.4005-4017, 2024 (SCI-Expanded, Scopus)

Yayın Türü: Makale / Tam Makale
Cilt numarası: 31 Sayı: 6
Basım Tarihi: 2024
Doi Numarası: 10.1245/s10434-024-15103-4
Dergi Adı: Annals of Surgical Oncology
Derginin Tarandığı İndeksler: Science Citation Index Expanded (SCI-EXPANDED), Scopus
Sayfa Sayıları: ss.4005-4017
Anahtar Kelimeler: Gastric cancer, Costs, Staging, Positron emission tomography, Laparoscopy, Gastrectomy
Sağlık Bilimleri Üniversitesi Adresli: Evet

Özet

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 18F-fluorodeoxyglucose positron emission tomography/computed tomography (18FFDG-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) 18FFDG-PET/CT first, then SL, (2) SL only, (3) 18FFDG-PET/CT only, and (4) neither SL nor 18FFDG-PET/CT. Costs were assessed on the basis of the prospective PLASTIC-study, which evaluated adding 18FFDG-PET/CT and SL to staging advanced gastric cancer (cT3–4 and/or cN+) in 18 Dutch hospitals. The Dutch Healthcare Authority provided 18FFDG-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: 18FFDG-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 18FFDG-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 18FFDG-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.