Springer Nature is making Coronavirus research free. View research | View latest news | Sign up for updates

Decision-tree sensitivity analysis for cost-effectiveness of whole-body FDG PET in the management of patients with non-small-cell lung carcinoma in Japan



Whole-body 2-fluoro-2-d-[18F]deoxyglucose [FDG] positron emission tomography (WB-PET) may be more cost-effective than chest PET because WB-PET does not require conventional imaging (CI) for extrathoracic staging.Methods: The cost-effectiveness of WB-PET for the management of Japanese patients with non-small-cell lung carcinoma (NSCLC) was assessed. Decision-tree sensitivity analysis was designed, based on the two competing strategies of WB-PET vs. CI. WB-PET was assumed to have a sensitivity and specificity for detecting metastases, of 90% to 100% and CI of 80% to 90%. The prevalences of M1 disease were 34% and 20%. One thousand patients suspected of having NSCLC were simulated in each strategy. We surveyed the relevant literature for the choice of variables. Expected cost saving (CS) and expected life expectancy (LE) for NSCLC patients were calculated.Results: The WB-PET strategy yielded an expected CS of $951US to $1,493US per patient and an expected LE of minus 0.0246 years to minus 0.0136 years per patient for the 71.4% NSCLC and 34% M1 disease prevalence at our hospital. PET avoided unnecessary bronchoscopies and thoracotomies for incurable and benign diseases. Overall, the CS for each patient was $833US to $2,010US at NSCLC prevalences ranging from 10% to 90%. The LE of the WB-PET strategy was similar to that of the CI strategy. The CS and LE minimally varied in the two situations of 34% and 20% M1 disease prevalence.


The introduction of a WB-PET strategy in place of CI for managing NSCLC patients is potentially cost-effective in Japan.

This is a preview of subscription content, log in to check access.


  1. 1.

    Gambhir SS, Hoh CK, Phelps ME, Madar I, Maddahi J. Decision tree sensitivity analysis for cost-effectiveness of FDG-PET in the staging and management of non-small-cell lung carcinoma,J Nucl Med 1996; 37: 1428–1436.

  2. 2.

    Scott WJ, Shepherd J, Gambhir SS. Cost-effectiveness of FDG-PET for staging non-small-cell lung cancer: a decision analysis,Ann Thoracic Surg 1998; 66: 1876–1885.

  3. 3.

    Weber W, Bulow H, Romer W, Prauer H, Gambhir SS, Schwaiger M. FDG-PET in solitary pulmonary nodules: A german cost-effectiveness analysis [Abstract].J Nucl Med 1997; 38 (suppl): 245p.

  4. 4.

    Gambhir SS, Shepherd J, Phelps ME. A theoretical decision analysis model for the cost effectiveness of newly emerging coincidence imaging (CI) technology in the presurgical staging of non-small-cell lung carcinoma (NSCLC) [Abstract].J. Nucl Med 1997; 38 (suppl): 245p.

  5. 5.

    Steinert HC, von Schulthess GK, Weder W. Effectiveness of whole-body FDG PET in staging of non-small-cell lung cancer (NSCLC) [Abstract].J Nucl Med 1998; 39 (suppl): 80p.

  6. 6.

    Kubota K, Yamada S, Fukuda H, Saito Y, Tanida T, Takahashi J, et al. Cost-effectiveness analysis of FDG-PET in the differential diagnosis and staging of lung cancer in Japan.KAKU IGAKU (Jpn J Nucl Med) 1997; 34: 329–336.

  7. 7.

    Kosuda S, Ichihara K, Watanabe M, Kobayashi H, Kusano S. Decision-tree sensitivity analysis for cost-effectiveness of chest FDG-PET in patients with a pulmonary nodule (non-small-cell lung carcinoma) in Japan.Chest 2000; 117: 346–353.

  8. 8.

    Lewis, P, Griffin S, Marsden P, Gee T, Nunan T Malsey M, et al., Whole-body18F-fluorodeoxyglucose positron emission tomography in preoperative evaluation of lung cancer.Lancet 1994; 344: 1265–1266.

  9. 9.

    Valk PE, Pounds TR, Hopkins DM, Haseman MK, Hofer GA, Greiss HB, et al. Staging non-small-cell lung cancer by whole-body positron emission tomographic imaging.Ann Thorac Surg 1995; 60: 1573–1582.

  10. 10.

    Bury TH, Dowlati A, Paulus P, Corhay JL, Benoit T, Kayembe JM, et al. Whole-body18FDG positron emission tomography in the staging of non-small cell lung cancer.Eur Respir J 1997; 10: 2529–2534.

  11. 11.

    Marom EM, McAdams HP, Erasmus JJ, Goodman PC, Culhane DK, Coleman RE, et al. Staging non-small cell lung cancer with whole-body PET.Radiology 1999; 212: 803–809.

  12. 12.

    Luce B, Simpson K. Methods of cost-effectiveness analysis: areas of consensus and debate.Clin Therapeutics 1995; 17: 109–125.

  13. 13.

    Saegusa C, Adachi H, Imanaka K, Shimizu M, Hashimura T, Yonezawa K, et al. Clinical evaluation of silent brain metastasis in lung cancer patients [in Japanese].Jpn J Lung Cancer 1990; 30: 521–526.

  14. 14.

    Mori K.The Integrated Basis of Respiratory Medicine [in Japanese]. Tokyo; Bunkodo, 1999: 507–566.

  15. 15.

    Habbema J, Bossuyt P, Dippel D, Marshall S, Hilden J. Analyzing clinical decision analysis.Stat Med 1990; 9: 1229–1242.

  16. 16.

    Motoyama A, Kono M, Adachi S, Kusumoto M, Itouji E, Kimura K, et al. Secondary screening for lung cancer by helical CT [in Japanese].Jpn J Lung Cancer 1995; 35: 883–890.

  17. 17.

    Yamada T, Miyazawa M, Kondo R, Machida E, Yoshida K, Haniuda M, et al. Analysis of small peripheral pulmonary tumors treated by thoracoscopic excisional biopsy (wedge resection) on a suspicion of primary lung cancer [in Japanese].Jpn J Lung Cancer 1999; 39: 137–143.

  18. 18.

    Nomori H, Horio H, Fuyuno G, Kobayashi R, Morinaga S, Suemasu K. Analysis of reasons for biopsy in small pulmonary nodules diagnosed by thoracoscopic and open-lung biopsy [in Japanese].Jpn J Lung Cancer 1999; 39: 35–41.

  19. 19.

    Kosuda, S, Ichihara, K, Watanabe M, Kobayashi H, Kusano S. decision tree sensitivity analysis for cost-effectiveness of chest FDG-PET in patients with a pulmonary tumor, (non-small cell carcinoma).KAKU IGAKU (Jpn J Nucl Med) 1998; 35: 395–404.

  20. 20.

    Kubota K, Matsuzawa T, Fujiwara T, Ito M, Hatazawa J, Ishiwata K, et al. Differential diagnosis of lung tumor with positron emission tomography: a prospective study.J Nucl Med 1990; 31: 1927–1932.

  21. 21.

    Jacobs MP, Mantil JC, Peterson CD, Dunigan KA, Nickerson JP, Borchert R, et al. FDG PET imaging of the chest.J Nucl Med 1992, 33 (suppl) 975–976

  22. 22.

    Knopp MV, Bishoff H, Oberdorfer F, van Kaick G. Positron emission tomography of the thorax. The current clinical status.Radiology 1992; 32: 290–295.

  23. 23.

    Slosman DO, Spiliopoulos A, Couson F, Nicod L, Louis O, Lemoine R, et al. Satellite PET and lung cancer: a prospective study in surgical patients.Nucl Med Comm 1993; 14: 955–961.

  24. 24.

    Scott WJ, Schwabe JL, Gupta NC, Dewan NA, Reeb SD, Sugimoto JT, et al. Positron emission tomography of lung tumors and mediastinal lymph nodes using [18F]fluoroglucose. The members of the PET-lung tumor study group.Ann Thorac Surg 1994; 58: 698–703.

  25. 25.

    Duhaylongsod FG, Lowe VJ, Patz EF Jr, Vaughn AL, Coleman RE, Wolfe WG. Detection of primary and recurrent lung cancer by means of F-18 fluorodeoxyglucose positron emission tomography.J Thorac Cardiovasc Surg 1995; 110: 130–139.

  26. 26.

    Hubner KF, Buonocore E, Singh SK, Gould HR, Cotten DW. Characterization of chest masses by FDG positron emission tomography.Clin Nucl Med 1995; 20: 293–298.

  27. 27.

    Sazon DA, Santiago SM, Soo Hoo GW, Khonsary A, Brown C, Mandelkern M, et al. Fluorodeoxyglucose-positron emission tomography in the detection and staging of lung cancer.Am J Resp Crit Care Med 1996; 153: 417–421.

  28. 28.

    Weber W, Romer W, Ziegler S. F-18-FDG PET in the evaluation of small solitary pulmonary nodules.J Nucl Med 1996; 37 (suppl): 111p.

  29. 29.

    Bury T, Dowlati A, Paulus P, Corhay JL, Hustinx R, Ghaye B, et al. Evaluation of the solitary pulmonary nodule by positron emission tomography imaging.Eur Resp J 1996; 9: 410–414.

  30. 30.

    Gross BH, Glazer GM, Orringer MB, Spizarny DL, Flint A. Bronchogenic carcinoma metastatic to normal-sized lymph nodes: frequency and significance.Radiology 1988; 166: 71–74.

  31. 31.

    McLoud TC, Bourgouin PM, Greenberg RW. Bronchogenic carcinoma: analysis of staging in the mediastinum with CT by correlative lymph node mapping and sampling.Radiology 1992; 182: 319–323.

  32. 32.

    White PG, Adams H, Crane MD, Butchart EG. Preoperative staging of carcinoma of the bronchus: can computed tomographic scanning reliably identify stage III tumors?Thorax 1994; 49: 951–957.

  33. 33.

    Primack S, Lee K, Logan P. Bronchogenic carcinoma: utility of CT in the evaluation of patients with suspected lesions.Radiology 1994; 193: 795–800.

  34. 34.

    Dillemans B, Deneffe G, Verschakelen J, Decramer M. Value of computed tomography and mediastinoscopy in preoperative evaluation of mediastinal nodes in non-small-cell lung cancer.Eur J Cardio Thorac Surg 1994; 8: 37–42.

  35. 35.

    Dwamena BA, Sonnad SS, Angobaldo JO, Wahl RL. Metastases from non-small cell lung cancer: Mediastinal staging in the 1990s-Meta-analytic comparison of PET and CT.Radiology 1999; 213: 530–536.

  36. 36.

    Wahl RL, Quint LE, Greenough RL, Meyer CR, White RI, Orringer MB. Staging of mediastinal non-small cell lung cancer with FDG PET, CT, and fusion images: preliminary prospective evaluation.Radiology 1994; 191: 371–377.

  37. 37.

    Madar I, Hoh C, Figlin RA, Holmes CE, Waters PF, Gambhir SS, et al. Cost-effective staging of non-small-cell lung carcinoma by whole-body PET-FDG imaging [Abstract].J Nucl Med 1995; 36 (suppl): 57p.

  38. 38.

    Valk PE, Pounds TR, Hopkins DM, Haseman MK, Hofer GA, Greiss HB. Staging of lung cancer by whole-body PET-FDG imaging [Abstract].J Nucl Med 1995; 36 (suppl): 95p.

  39. 39.

    Earnest IV F, Ryu JH, Miller GM, Luetmer PH, Forstrom LA, Burnett OL, et al. Suspected non-small cell lung cancer: Incidence of occult brain and skeletal metastases and effectiveness of imaging for detection-pilot study.Radiology 1999; 211: 137–145.

  40. 40.

    Bury T, Barreto A, Daenen F, Barthelemy N, Ghaye B, Rigo P. Fluorine-18 deoxyglucose positron emission tomography for the detection of bone metastases in patients with non-small cell lung cancer.Eur J Nucl Med 1998; 25: 1244–1247.

  41. 41.

    Ikeda T. Outcome of lung cancer patients with surgical therapy [in Japanese].Rinsho Seijnbyo 1995; 25: 1153–1157.

  42. 42.

    Moroff S, Pauker S. What to do when the patient outlives the literature, or DEALE-ing with a full deck.Med Decis Making 1983; 3: 313–338.

  43. 43.

    Sasaki Y. Assessment of cost-effective nuclear medicine practice in Japan.Acad Radiol 1996; 3: S106-S108.

  44. 44.

    Pugatch RD. Radiologic evaluation in chest malignancies. A review of imaging modalities.Chest 1995; 107 (suppl): 294S-297S.

  45. 45.

    Noguchi M, Morikawa A, Kawasaki M, Matsuno Y, Yamada T, Hirohashi S, et al. Small adenocarcinoma of the lung. Histologic characteristics and prognosis.Cancer 1995; 75: 2844–2852.

  46. 46.

    Ko JP, Shepard JO, Drucker EA, Aquino SL, Sharma A, Sabloff B, et al. Factors influencing pneumothorax rate at lung biopsy: Are dwell time and angle of pleural puncture contributing factors?Radiology 2001; 218: 491–496.

  47. 47.

    Bragg DG. Current applications of imaging procedures in the patient with lung cancer.Int J Radiat Oncol Biol Phys 1991; 21: 847–885.

  48. 48.

    Valk PE, Pounds TR, Tesa RD, Hopkins DM, Haseman MK. Cost-effectiveness of PET imaging in clinical oncology.Nucl Med Biol 1996; 23: 737–743.

  49. 49.

    Weinstein MC, Stason WB. Foundations of cost-effectiveness analysis for health and medical practices.N Eng J Med 1977; 296: 716–721.

  50. 50.

    Gold MR, Siegel JE, Russell LB, Weinsrein MC, eds.Cost-Effectiveness in Health and Medicine, New York: Oxford University Press, 1996.

Download references

Author information

Correspondence to Shigeru Kosuda.

Rights and permissions

Reprints and Permissions

About this article

Cite this article

Kosuda, S., Ichihara, K., Watanabe, M. et al. Decision-tree sensitivity analysis for cost-effectiveness of whole-body FDG PET in the management of patients with non-small-cell lung carcinoma in Japan. Ann Nucl Med 16, 263–271 (2002).

Download citation

Key words

  • cost-benefit analysis
  • fluorine-18-deoxyglucose
  • emission-computed tomography
  • non-small-cell lung carcinoma
  • life expectancy