Transcript AIPES_Symposium_2015_files/fisher presx

PET/CT as a Cost Saver in Oncology
Dream or Reality?
BM Fischer MD, DMSci
Dept of Clinical Physiology, Nuclear Medicine and PET
Rigshospitalet, University of Copenhagen
What is so special about PET/CT?
• PET characteristics
• Very high sensitivity
• Micro dosing
• Quantitative
• Translational
• Whole body
• So much more than FDG…
June
June
October
June
October
May
DIAGNOSING – STAGING – RT PLANNING
THERAPY EVALUATION
FOLLOW-UP
Imaging constitutes a minor part of cancer
care expenditures
PET
320 million
Cancer expenditures
Non-imaging:
USD 30.6 billion
Yang & Czernin, JNM 2011;86S-92S
Imaging
1.2 billion
– but outpaces
the increase in
total cancer
costs
Dinan et al, JAMA 2010;1625-31
Increase in imaging cost
mainly driven by PET
Dinan et al, JAMA 2010;1625-31
PET, Cost and survival among 51,374
Medicare beneficiares with lung cancer 19962005
Dinan, J Thorac Onc 2014;512-18
PET, Cost and survival among 51,374
Medicare beneficiares with lung cancer 19962005
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Increasing total health care costs
 Increasing use of chemotherapy (not temporarily
correlated with the use of PET)
 Increase in costs associated with comorbidity
Dinan, J Thorac Onc 2014;512-18
PET, Cost and survival among 51,374
Medicare beneficiares with lung cancer 19962005
•
Increasing total health care costs
 Increasing use of chemotherapy (not temporarily
correlated with the use of PET)
 Increase in costs associated with comorbidity
•
Significant increase in the use of PET
 Stage-migration
 Reduced rates of surgery and radiotherapy
 Decreasing inpatient health care cost
Dinan, J Thorac Onc 2014;512-18
Brief introduction to Health Economy
CUA - Cost Utility Analysis
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Compares alternative interventions on cost and
effect adjusted for quality (quality of life)
Standardized and validated interviews or
questionnaires a prerequisite
Enables broader comparison
ICER, i.e. $/QALY
CEA - Cost Effectiveness Analysis
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Compares effectiveness (accuracy, survival) and costs
between alternative interventions – i.e. EUR/correct
diagnosis
Most frequently applied method in health
Only valid in direct comparison of different
methods/treatment
Based on a clinical trial or modeling
CBA - Cost Benefit Analysis
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Compares alternative interventions on cost and the
value of an effect.
Compare present value of benefit and present value of
cost
Rarely used in health sciences, but enables us to put a
value on the benefit/effect and thus compare nonrelated interventions. What is better: a new scanner or a
new bicycle road..
STAGING LUNG CANCER
Cost-Effectiveness Analysis of PET in Lung Cancer
Verboom, Eur J Nucl Med Mol Imaging 2003;30:1444-9
Søgaard, Eur J Nucl Med Mol Imaging 2011;38:802-9
Cost-Effectiveness Analysis of PET in Lung Cancer
Verboom, Eur J Nucl Med Mol Imaging 2003;30:1444-9
Søgaard, Eur J Nucl Med Mol Imaging 2011;38:802-9
Cost-Effectiveness Analysis of PET in Lung Cancer
Verboom, Eur J Nucl Med Mol Imaging 2003;30:1444-9
Søgaard, Eur J Nucl Med Mol Imaging 2011;38:802-9
Model based cost-effectiveness analysis
X10.000
THERAPY PLANNING & EVALUATION
Cost-effectiveness of FET-PET for treatment management
in patients with recurrent high-grade glioma
Therapy
planning
Courtesy of Dr. Ian Law
Cost-effectiveness of FET-PET for treatment management
in patients with recurrent high-grade glioma
Therapy
planning
2 months
after radiotherapy
Courtesy of Dr. Ian Law
Cost-effectiveness of FET-PET for treatment management
in patients with recurrent high-grade glioma
Therapy
planning
2 months
after radiotherapy
Courtesy of Dr. Ian Law
Cost-effectiveness of FET-PET for treatment management
in patients with recurrent high-grade glioma
Treatment with
bevacizumab and
irinotecan
Heinzel, JNM 2013;1217-1222
Cost-effectiveness of FET-PET for treatment management
in patients with recurrent high-grade glioma
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Heinzel, JNM 2013;1217-1222
For diagnosing recurrence
and estimation of therapy
response: NNT=3
• ICER = 5,725 €
Cost-effectiveness of FET-PET for treatment management
in patients with recurrent high-grade glioma
Heinzel, JNM 2013;1217-1222
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For diagnosing recurrence
and estimation of therapy
response: NNT=3
• ICER = 5,725 €
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Costs for therapy not
included, but estimated at
8,000 €/ 4 week
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No estimation of survival
nor QALY
THERAPY PLANNING & EVALUATION
MODEL-BASED CEA OF RADIATION THERAPY IN
LUNG CANCER
CRT
60/70 Gy
2 Gy daily
42 days
X50,000
PET-ART
54-79 Gy
1.8 Gy
twice daily
25 days
Bongers, Int J Radiation Oncol Biol Phys 2015; 857-65
MODEL-BASED CEA OF RADIATION THERAPY IN
LUNG CANCER
CRT
60/70 Gy
2 Gy daily
42 days
Relapse
Adverse events
Survival/LY
QALY
Costs
PET-ART
54-79 Gy
1.8 Gy
twice daily
25 days
Relapse
Adverse events
Survival/LY
QALY
Costs
X50,000
Bongers, Int J Radiation Oncol Biol Phys 2015; 857-65
Incremental Costs
Incremental LY
PET-ART vs CRT:
• €1360 / LY saved
• €1744 /QALY
Bongers, Int J Radiation Oncol Biol Phys 2015; 857-65
No!
But, the PET/CT is the tool that
enables improved RT planning,
increasing dose and tumour
control
FOLLOW-UP
PET/CT for stratification of follow-up intensity after
radical radiotherapy for head and neck cancer
Standard cohort
treated 2005-2007
CR
noCR
PET stratified cohort
2009-2011
CMR
noCMR
Routine clinical follow-up every
3 months
Follow-up
every
6 mo
Time to detection of recurrence
Treatment and survival
Costs
Shah, Oral Oncology 2015; 529-35
Standard cohort
treated 2005-2007
noCR
CR
PET stratified cohort
2009-2011
noCMR
Routine clinical follow-up every
3 months in two years
CMR
Follow-up
every
6 mo
Time to detection of recurrence: NS
Treatment and survival: NS
Costs: €1660 savings per patient
Shah, Oral Oncology 2015; 529-35
Standard cohort
treated 2005-2007
noCR
CR
PET stratified cohort
2009-2011
noCMR
Routine clinical follow-up every
3 months in two years
CMR
Follow-up
every
6 mo
Time to detection of recurrence: NS
Treatment and survival: NS
Costs: €1660 savings per patient
Shah, Oral Oncology 2015; 529-35
PET/CT as a Cost Saver in Oncology
Dream or Reality?
PET/CT is a valuable signpost with a –partially
deserved- pricy reputation
Used wisely PET/CT is the key to cost-effective
improvements in the care of cancer patients and
sometimes even a cost saver
PET/CT can play a key role in the development and
implementation of personalized medicine
PET/CT as a Cost Saver in Oncology
Dream & Reality
THANK YOU
FOR YOUR ATTENTION