TY - JOUR
T1 - Impact of 18FFDG-PET/CT and Laparoscopy in Staging of Locally Advanced Gastric Cancer
T2 - A Cost Analysis in the Prospective Multicenter PLASTIC-Study
AU - de Jongh, Cas
AU - van der Meulen, Miriam P.
AU - Gertsen, Emma C.
AU - Brenkman, Hylke J. F.
AU - van Sandick, Johanna W.
AU - van Berge Henegouwen, Mark I.
AU - Gisbertz, Suzanne S.
AU - Luyer, Misha D. P.
AU - Nieuwenhuijzen, Grard A. P.
AU - van Lanschot, Jan J. B.
AU - Lagarde, Sjoerd M.
AU - Wijnhoven, Bas P. L.
AU - de Steur, Wobbe O.
AU - Hartgrink, Henk H.
AU - Stoot, Jan H. M. B.
AU - Hulsewe, Karel W. E.
AU - Spillenaar Bilgen, Ernst Jan
AU - van Det, Marc J.
AU - Kouwenhoven, Ewout A.
AU - Daams, Freek
AU - van der Peet, Donald L.
AU - van Grieken, Nicole C. T.
AU - Heisterkamp, Joos
AU - van Etten, Boudewijn
AU - van den Berg, Jan-Willem
AU - Pierie, Jean-Pierre
AU - Eker, Hasan H.
AU - Thijssen, Annemieke Y.
AU - Belt, Eric J. T.
AU - van Duijvendijk, Peter
AU - Wassenaar, Eelco
AU - Wevers, Kevin P.
AU - Hol, Lieke
AU - Wessels, Frank J.
AU - Haj Mohammad, Nadia
AU - Frederix, Geert W. J.
AU - van Hillegersberg, Richard
AU - Siersema, Peter D.
AU - Vegt, Erik
AU - Ruurda, Jelle P.
N1 - Publisher Copyright: © The Author(s) 2024.
PY - 2024
Y1 - 2024
N2 - 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.
AB - 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.
KW - Costs
KW - Gastrectomy
KW - Gastric cancer
KW - Laparoscopy
KW - Positron emission tomography
KW - Staging
UR - http://www.scopus.com/inward/record.url?scp=85188520124&partnerID=8YFLogxK
U2 - 10.1245/s10434-024-15103-4
DO - 10.1245/s10434-024-15103-4
M3 - Article
C2 - 38526832
SN - 1068-9265
JO - Annals of surgical oncology
JF - Annals of surgical oncology
ER -