Introduction and Objectives This retrospective study compares the cost of PET scans with the cost of surgical intervention; for patients with lung cancer suitable for radical therapy.
Methods The number of patients referred for PET scans by our lung Multidisciplinary Team (MDT) in 2010 was identified from our lung cancer database. All patients' management plans were reviewed via our electronic lung cancer database (Somerset Cancer Registry), and copies of MDT and clinic letters. The cost of PET scans, lobectomy and mediastinoscopy were provided by our thoracic surgery tertiary centre, the Bristol Royal Infirmary, as follows; PET scan £850, uncomplicated lobectomy £6000, uncomplicated mediastinoscopy £2000.
Results In 2010 the lung MDT referred 84 patients for PET scans (see Abstract P196 table 1). 52 scans were requested with the intention of referring patients for radical treatment. Of these 52 scans, 22 patients had their lung cancer upstaged following PET scan (three increased tumour staging, nine increased nodal staging, and 10 identified distal metastases). 26 patients had unchanged staging on PET scan compared with CT scan. Four patients required further imaging. The total cost of PET scans was 52×£850=£44 200. As a result of upstaging on PET scan, 22 patients were not referred for radical surgery (lobectomy) with the potential cost saving of 22×£6000=£132 000. Furthermore, in view of PET scan activity identified in mediastinal nodes, nine patients were not referred for mediastinoscopy with the potential cost saving of 9×£2000=£18 000. Therefore the total potential cost saving after accounting for PET scan expenditure was £105 800.
Conclusions The study demonstrates the cost effectiveness of PET scanning in the radical treatment of lung cancer patients in a district general hospital. Limitations of the study include an underestimation of the cost of surgery as some patients will develop post-operative complications. Furthermore, the study has not included the cost of palliative treatments provided to patients who were not referred for radical treatment after PET scan. The study did not assess the concurrent advantages of reduction in morbidity and mortality for patients avoiding unnecessary surgical intervention.