10. Positron Emission Tomography in the Presurgical Evaluation of Patients with Resectable Liver Metastases from Colorectal Carcinoma Detected by Computed Tomography with Arterial Portography

Purpose: To assess the cost of implementing ¹⁸F-Fluorodeoxyglucose (¹⁸FDG) PET scan in the presurgical evaluation of patients with hepatic metastases from colorectal cancer (CRC) detected by Computed Tomography with arterial portography (CTAP).

Methods: We performed a cost analysis of two diagnostic pathways based on a population of CRC patients with metastatic disease limited to the liver by (CTAP). The payers' perspective was utilized. The algorithms compared ¹⁸FDG-PET with Computed Tomography (CT) versus CT alone. Patients found to have extrahepatic disease by ¹⁸FDG-PET or CT were assigned to palliative care. Patients found to be negative for extrahepatic extension were assumed to be surgically resectable. The prevalence of extrahepatic disease, true and false positives and negatives for CT and ¹⁸FDG-PET were extracted from published reports (Medline, 1991 to 1999). Three possible outcomes for surgery were considered: uncomplicated, complicated, and death. Surgical complications considered were: urinary tract infection, wound sepsis, intra-abdominal abscess, septicemia, pneumonia, deep venous thrombosis, pulmonary embolism, anemia requiring transfusion, and myocardial infarction. Complication rates, costs for CT, CTAP, ¹⁸FDG-PET, surgery and post-surgical complications were obtained from HCFA published data (1997-2000). Palliative care costs were assumed to be identical in both branches.

Results: Average expected cost per patient with ¹⁸FDG-PET was $16,921, compared to $21,693 for a patient without PET scan. This represents net savings of $4,772 if PET is included in the diagnostic work up.

Conclusion: Integration of ¹⁸FDG-PET in the presurgical evaluation of patients with liver metastases from CRC by CTP would substantially reduce overall costs.