Cost-effectiveness of second-line diagnostic investigations in patients included in the DANTE trial: a randomized controlled trial of lung cancer screening with low-dose computed tomography

Egesta Lopci, Angelo Castello, Emanuela Morenghi, Dario Tanzi, Silvio Cavuto, Fabio Lutman, Giuseppe Chiesa, Elena Vanni, Marco Alloisio, Maurizio Infante

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Abstract

AIM: The aim of this study was to analyze the economic efficiency of second-line diagnostic investigations in patients with undetermined lung nodules. PARTICIPANTS AND METHODS: A retrospective review of all surgical cases included in the DANTE trial from 2001 to 2006 for lung cancer screening was performed. Overall, 217 patients and 261 lung nodules were analyzed. The cohort was divided into patients investigated with PET and/or computed tomography (CT)-guided biopsy (PET-CTB protocol; N=100), compared with those assessed with serial low-dose CT scans (standard protocol; N=161). Outpatient's and inpatient's costs were expressed in euros and derived from the Italian National Health Service. Ineffective costs were defined as the cost of procedures that lead to avoidable surgical intervention. RESULTS: The diagnostic accuracy of the two protocols was 91% for the standard (sensitivity 100%, specificity 91%, positive predictive value 26%, and negative predictive value 100%) and 90% for the PET-CTB protocol (sensitivity 98%, specificity 81%, positive predictive value 85%, and negative predictive value 97%). Average costs for outpatient's diagnostics were 694 and 1.462 euros, respectively, for the standard and PET-CTB protocol. Average inpatient's costs for both protocols were 12.121 euros. The two protocols showed comparable effectiveness in terms of outpatient's costs (94 and 90%, respectively; P=0.252). Inpatient's costs were effective in 36% of cases monitored according to the standard protocol compared with 85% of patients investigated with PET-CTB protocol. Ineffective costs corresponded to 64 and 15%, respectively (P<0.0001). CONCLUSION: Despite a higher average cost for outpatient's diagnostics, the implementation of PET imaging with or without CT-guided needle biopsy in the workup of suspicious lung nodules results in reduced unnecessary harm and costs related to inpatient's procedures.

Original languageEnglish
Pages (from-to)508-516
Number of pages9
JournalNuclear Medicine Communications
Volume40
Issue number5
DOIs
Publication statusPublished - May 1 2019

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Early Detection of Cancer
Cost-Benefit Analysis
Lung Neoplasms
Randomized Controlled Trials
Tomography
Costs and Cost Analysis
Inpatients
Outpatients
Lung
Sensitivity and Specificity
National Health Programs
Needle Biopsy
Economics
Biopsy
PET protocol

ASJC Scopus subject areas

  • Radiology Nuclear Medicine and imaging

Cite this

@article{cdb5c022e67c49c196b1d319fa0b06c6,
title = "Cost-effectiveness of second-line diagnostic investigations in patients included in the DANTE trial: a randomized controlled trial of lung cancer screening with low-dose computed tomography",
abstract = "AIM: The aim of this study was to analyze the economic efficiency of second-line diagnostic investigations in patients with undetermined lung nodules. PARTICIPANTS AND METHODS: A retrospective review of all surgical cases included in the DANTE trial from 2001 to 2006 for lung cancer screening was performed. Overall, 217 patients and 261 lung nodules were analyzed. The cohort was divided into patients investigated with PET and/or computed tomography (CT)-guided biopsy (PET-CTB protocol; N=100), compared with those assessed with serial low-dose CT scans (standard protocol; N=161). Outpatient's and inpatient's costs were expressed in euros and derived from the Italian National Health Service. Ineffective costs were defined as the cost of procedures that lead to avoidable surgical intervention. RESULTS: The diagnostic accuracy of the two protocols was 91{\%} for the standard (sensitivity 100{\%}, specificity 91{\%}, positive predictive value 26{\%}, and negative predictive value 100{\%}) and 90{\%} for the PET-CTB protocol (sensitivity 98{\%}, specificity 81{\%}, positive predictive value 85{\%}, and negative predictive value 97{\%}). Average costs for outpatient's diagnostics were 694 and 1.462 euros, respectively, for the standard and PET-CTB protocol. Average inpatient's costs for both protocols were 12.121 euros. The two protocols showed comparable effectiveness in terms of outpatient's costs (94 and 90{\%}, respectively; P=0.252). Inpatient's costs were effective in 36{\%} of cases monitored according to the standard protocol compared with 85{\%} of patients investigated with PET-CTB protocol. Ineffective costs corresponded to 64 and 15{\%}, respectively (P<0.0001). CONCLUSION: Despite a higher average cost for outpatient's diagnostics, the implementation of PET imaging with or without CT-guided needle biopsy in the workup of suspicious lung nodules results in reduced unnecessary harm and costs related to inpatient's procedures.",
author = "Egesta Lopci and Angelo Castello and Emanuela Morenghi and Dario Tanzi and Silvio Cavuto and Fabio Lutman and Giuseppe Chiesa and Elena Vanni and Marco Alloisio and Maurizio Infante",
year = "2019",
month = "5",
day = "1",
doi = "10.1097/MNM.0000000000000993",
language = "English",
volume = "40",
pages = "508--516",
journal = "Nuclear Medicine Communications",
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TY - JOUR

T1 - Cost-effectiveness of second-line diagnostic investigations in patients included in the DANTE trial

T2 - a randomized controlled trial of lung cancer screening with low-dose computed tomography

AU - Lopci, Egesta

AU - Castello, Angelo

AU - Morenghi, Emanuela

AU - Tanzi, Dario

AU - Cavuto, Silvio

AU - Lutman, Fabio

AU - Chiesa, Giuseppe

AU - Vanni, Elena

AU - Alloisio, Marco

AU - Infante, Maurizio

PY - 2019/5/1

Y1 - 2019/5/1

N2 - AIM: The aim of this study was to analyze the economic efficiency of second-line diagnostic investigations in patients with undetermined lung nodules. PARTICIPANTS AND METHODS: A retrospective review of all surgical cases included in the DANTE trial from 2001 to 2006 for lung cancer screening was performed. Overall, 217 patients and 261 lung nodules were analyzed. The cohort was divided into patients investigated with PET and/or computed tomography (CT)-guided biopsy (PET-CTB protocol; N=100), compared with those assessed with serial low-dose CT scans (standard protocol; N=161). Outpatient's and inpatient's costs were expressed in euros and derived from the Italian National Health Service. Ineffective costs were defined as the cost of procedures that lead to avoidable surgical intervention. RESULTS: The diagnostic accuracy of the two protocols was 91% for the standard (sensitivity 100%, specificity 91%, positive predictive value 26%, and negative predictive value 100%) and 90% for the PET-CTB protocol (sensitivity 98%, specificity 81%, positive predictive value 85%, and negative predictive value 97%). Average costs for outpatient's diagnostics were 694 and 1.462 euros, respectively, for the standard and PET-CTB protocol. Average inpatient's costs for both protocols were 12.121 euros. The two protocols showed comparable effectiveness in terms of outpatient's costs (94 and 90%, respectively; P=0.252). Inpatient's costs were effective in 36% of cases monitored according to the standard protocol compared with 85% of patients investigated with PET-CTB protocol. Ineffective costs corresponded to 64 and 15%, respectively (P<0.0001). CONCLUSION: Despite a higher average cost for outpatient's diagnostics, the implementation of PET imaging with or without CT-guided needle biopsy in the workup of suspicious lung nodules results in reduced unnecessary harm and costs related to inpatient's procedures.

AB - AIM: The aim of this study was to analyze the economic efficiency of second-line diagnostic investigations in patients with undetermined lung nodules. PARTICIPANTS AND METHODS: A retrospective review of all surgical cases included in the DANTE trial from 2001 to 2006 for lung cancer screening was performed. Overall, 217 patients and 261 lung nodules were analyzed. The cohort was divided into patients investigated with PET and/or computed tomography (CT)-guided biopsy (PET-CTB protocol; N=100), compared with those assessed with serial low-dose CT scans (standard protocol; N=161). Outpatient's and inpatient's costs were expressed in euros and derived from the Italian National Health Service. Ineffective costs were defined as the cost of procedures that lead to avoidable surgical intervention. RESULTS: The diagnostic accuracy of the two protocols was 91% for the standard (sensitivity 100%, specificity 91%, positive predictive value 26%, and negative predictive value 100%) and 90% for the PET-CTB protocol (sensitivity 98%, specificity 81%, positive predictive value 85%, and negative predictive value 97%). Average costs for outpatient's diagnostics were 694 and 1.462 euros, respectively, for the standard and PET-CTB protocol. Average inpatient's costs for both protocols were 12.121 euros. The two protocols showed comparable effectiveness in terms of outpatient's costs (94 and 90%, respectively; P=0.252). Inpatient's costs were effective in 36% of cases monitored according to the standard protocol compared with 85% of patients investigated with PET-CTB protocol. Ineffective costs corresponded to 64 and 15%, respectively (P<0.0001). CONCLUSION: Despite a higher average cost for outpatient's diagnostics, the implementation of PET imaging with or without CT-guided needle biopsy in the workup of suspicious lung nodules results in reduced unnecessary harm and costs related to inpatient's procedures.

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U2 - 10.1097/MNM.0000000000000993

DO - 10.1097/MNM.0000000000000993

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