TY - JOUR
T1 - Increased Utilization of Positron Emission Tomography/Computed Tomography (PET/CT) Imaging and Its Economic Impact for Patients Diagnosed With Bladder Cancer
AU - Huo, Jinhai
AU - Chu, Yiyi
AU - Chamie, Karim
AU - Smaldone, Marc C.
AU - Boorjian, Stephen A.
AU - Baillargeon, Jacques G.
AU - Kuo, Yong Fang
AU - Kerr, Preston
AU - O'Malley, Padraic
AU - Orihuela, Eduardo
AU - Tyler, Douglas S.
AU - Freedland, Stephen J.
AU - Giordano, Sharon H.
AU - Vikram, Raghu
AU - Kamat, Ashish M.
AU - Williams, Stephen B.
N1 - Publisher Copyright:
© 2017 Elsevier Inc.
PY - 2018/2
Y1 - 2018/2
N2 - Background: The purpose of this study was to examine temporal nationwide utilization patterns and predictors for use of positron emission tomography/computed tomography (PET/CT) in comparison with magnetic resonance imaging (MRI) and computed tomography (CT) among patients diagnosed with bladder cancer. Materials and Methods: A total of 36,855 patients aged 66 years or older diagnosed with clinical stage TI-IV, N0M0 bladder cancer from 2004 to 2011 were analyzed. We used multivariable logistic regression analyses to discern factors associated with receipt of imaging within 12 months from diagnosis. The Cochran-Armitage test for trend was used to determine changes in the proportion of patients receiving imaging after cancer diagnosis. Results: Independent of clinical stage, there was marked increase in use of PET/CT throughout the study period (2011 vs. 2004: odds ratio, 17.55; 95% confidence interval, 10.14-30.38; P <.001). Although use of CT imaging remained stable during the study period, there was significantly decreased utilization of MRI (odds ratio, 0.60; 95% confidence interval, 0.49-0.75; P <.001) in 2011 versus 2004. The mean incremental cost of PET/CT versus CT and MRI was $1040 and $612 (in 2016 dollars), respectively. Extrapolating these findings to the patients with bladder cancer in the United States results in excess spending of $11.6 million for PET/CT imaging. Conclusion: We identified rapid adoption of PET/CT imaging independent of clinical stage, resulting in excess national spending of $11.6 million for this imaging modality alone. Further value-based research discerning the clinical versus economic benefits of advanced imaging among patients with bladder cancer are needed. The American Society of Clinical Oncology's Value of Cancer Care Task Force is promoting sustainable high-quality and high–value-based cancer care. This study examines utilization trends and costs associated with advanced imaging in patients with bladder cancer, using a large population-based cancer registry data. We found a significant shift from low-cost to high-cost imaging without evidence documenting clinical superiority.
AB - Background: The purpose of this study was to examine temporal nationwide utilization patterns and predictors for use of positron emission tomography/computed tomography (PET/CT) in comparison with magnetic resonance imaging (MRI) and computed tomography (CT) among patients diagnosed with bladder cancer. Materials and Methods: A total of 36,855 patients aged 66 years or older diagnosed with clinical stage TI-IV, N0M0 bladder cancer from 2004 to 2011 were analyzed. We used multivariable logistic regression analyses to discern factors associated with receipt of imaging within 12 months from diagnosis. The Cochran-Armitage test for trend was used to determine changes in the proportion of patients receiving imaging after cancer diagnosis. Results: Independent of clinical stage, there was marked increase in use of PET/CT throughout the study period (2011 vs. 2004: odds ratio, 17.55; 95% confidence interval, 10.14-30.38; P <.001). Although use of CT imaging remained stable during the study period, there was significantly decreased utilization of MRI (odds ratio, 0.60; 95% confidence interval, 0.49-0.75; P <.001) in 2011 versus 2004. The mean incremental cost of PET/CT versus CT and MRI was $1040 and $612 (in 2016 dollars), respectively. Extrapolating these findings to the patients with bladder cancer in the United States results in excess spending of $11.6 million for PET/CT imaging. Conclusion: We identified rapid adoption of PET/CT imaging independent of clinical stage, resulting in excess national spending of $11.6 million for this imaging modality alone. Further value-based research discerning the clinical versus economic benefits of advanced imaging among patients with bladder cancer are needed. The American Society of Clinical Oncology's Value of Cancer Care Task Force is promoting sustainable high-quality and high–value-based cancer care. This study examines utilization trends and costs associated with advanced imaging in patients with bladder cancer, using a large population-based cancer registry data. We found a significant shift from low-cost to high-cost imaging without evidence documenting clinical superiority.
KW - Bladder cancer
KW - Imaging
KW - PET/CT
KW - Positron emission tomography–computed tomography
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U2 - 10.1016/j.clgc.2017.07.018
DO - 10.1016/j.clgc.2017.07.018
M3 - Article
C2 - 28826932
AN - SCOPUS:85027517964
SN - 1558-7673
VL - 16
SP - e99-e111
JO - Clinical Genitourinary Cancer
JF - Clinical Genitourinary Cancer
IS - 1
ER -