Cost Analysis of PET/CT Versus CT as Surveillance for Stage III Non–Small-Cell Lung Cancer After Definitive Radiation Therapy

We estimated and compared the costs of positron emission tomography (PET)/computed tomography (CT) versus CT for surveillance of patients with stage III non–small-cell lung cancer and identified patient and provider demographic characteristics associated with preference for PET/CT. PET/CT was associated with higher costs for 18 months post-treatment, but the difference was borderline statistically significant at 24 months. Consistent with national guidelines, PET/CT surveillance was not cost-saving and did not provide an economic benefit over CT. Introduction: A previous study showed that use of positron emission tomography (PET)/computed tomography (CT) for surveillance after treatment of non–small-cell lung cancer (NSCLC) does not yield a detection or survival benefit over the use of chest CT. However, PET/CT remains a common method of follow-up imaging. Here we estimated and compared the costs of PET/CT versus CT for surveillance of patients with stage III NSCLC and identified patient and provider demographic characteristics associated with preference for use of PET/CT. Patients and Methods: We reviewed 178 patients with stage III NSCLC who had received ≥ 1 PET/CT scan within 6 months of completing radiotherapy (n = 89) or had received CT after radiotherapy (n = 89) from 2000 to 2011. Costs were measured according to Medicare payments converted from institutional billing records. Total and imaging costs were analyzed at 6, 12, 18, and 24 months after the end of treatment. Patient and provider demographic characteristics were also evaluated for potential associations with PET/CT use. Results: Total costs in the PET/CT group were higher during the first 18 months after treatment (P =.002 at 6 months, P =.019 at 12 months, and P =.018 at 18 months) but was marginally significant (P =.05) at 24 months. In univariate analysis of demographic variables, patients who lived in a state different from the treatment center might have been more likely to receive PET/CT (odds ratio [OR], 1.76; P =.051). In multivariate analysis, patients treated in 2007 to 2010 (OR, 29.9; P <.001) or 2003 to 2006 (OR, 11.6; P =.002) were more likely to receive PET/CT than patients treated in 1999 to 2002. In addition, radiation oncologists with > 10 years of experience were more likely to use PET/CT than those with less experience, although this result might be confounded by the small number of providers. Conclusion: Use of PET/CT was associated with higher costs for 18 months after treatment, but the difference was at the borderline of statistical significance at 24 months.