Clinical Practice Guidelines - National Health and Medical Research ...

Table 22.7 Results of studies investigating costs and consequences of various diagnostic
procedures
Study Countr
y
Miles 70
Valk et
al 71
Valk et
al 72
Harewood
and
Wiersema 73
Brown et
al 74
Australi
a
United
States
United
States
United
States
United
Kingdo
m
Study question Conclusion
Evaluation of FDG–PET
costs for preoperative
evaluation of recurrent
cancer and comparison of
decision-tree analysis
results with actual
experience
Evaluation of effectiveness,
impact and costs of PET for
patients with of recurrent
cancer
Assessment of impact and
costs of PET for patients
with recurrent cancer
Comparison of abdominal
and pelvic CT vs
abdominal CT + EUS vs
abdominal CT + pelvic
MRI
Comparison of MRI vs
DRE vs EUS in staging
CRC
Studies using decision-tree analysis suggest
a cost saving of $A2301.27/patient, with
sensitivity analysis indicating the results are
robust. Studies based on actual experience
suggest a smaller saving of $A230.75. The
discrepancy suggests decision-tree models
may not reflect actual practice.
PET shows more sensitivity (93% vs 69%)
and specificity (98% vs 96%) than CT. PET
may avoid unnecessary surgery, thereby
reducing costs. Total PET costs were
$US140,400 ($A247,092). Savings from
surgery avoided would be $US3003
($A5285)/patient.
PET suggested change in surgical management
in 35% patients. Costs for procedures that
would have been avoided and PET were
$US300,000 ($A601,497) and $US112,000
($A224,559), a savings/cost ratio of 2:5. If
PET replaced CT, the net cost would be
$US68,000 ($A136,339), a savings/cost
ratio of 4:4.
Abdominal CT+ EUS is the most costeffective
approach (recurrence-free rate of
87%, CER = $US24,668 ($A39,326)/yr). It
dominated the other two strategies. Results
are sensitive to sensitivity and specificity of
EUS and pelvic MRI but remained mostly
cost-effective if the sensitivity of EUS
>66% and pelvic MRI 78% and pelvic MRI