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An Economic Evaluation of Positron Emission Tomography (PET) and Positron Emission Tomography/Computed Tomography (PET/CT) for the Diagnosis of Breast Cancer Recurrence

Health Technology Assessment, No. 15.18

P Auguste, P Barton, C Hyde, and TE Roberts.

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Southampton (UK): NIHR Journals Library; 2011 Apr.
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To review the published economic studies that have evaluated positron emission tomography/computed tomography (PET/CT) in the treatment of recurrent breast cancer, and to develop and carry out a model-based economic evaluation to investigate the relative cost-effectiveness of PET/CT to detect breast cancer recurrence compared with conventional work-up.

Data sources:

A systematic review of economic and diagnostic evidence for PET/CT in diagnosis of breast cancer recurrence. The original databases searched include MEDLINE (Ovid) (1950 to week 5 May 2009), EMBASE (Ovid) (1980 to 2009 week 22) and the NHS Economic Evaluation Database. An updated search was conducted for each database from May 2009 to week 4 April 2010.


A decision tree was developed in treeage software (TreeAge Software Inc., Williamstown, MA, USA). The relevant data on accuracy, sensitivity and specificity of each diagnostic test were linked in the model, to costs and the primary outcome measure, cost per quality-adjusted life-year (QALY). The model estimated the mean cost associated with each diagnostic procedure and assumed that patients entering the model were aged 50–75 years. The results of the cost-effectiveness analysis are presented in terms of the incremental cost-effectiveness ratios (ICERs).


The ICER for the strategy of PET compared with conventional work-up was estimated at £29,300 per QALY; the ICER for PET/CT compared with PET was £31,000 per QALY; and the ICER for PET/CT combined with conventional work-up versus PET/CT was £42,100. Clearly, for each additional diagnostic test that is added to PET, the more expensive the package becomes, but also the more effective it becomes in terms of QALYs gained. The probabilistic sensitivity analysis shows that at a willingness-to-pay threshold of £20,000 per QALY, conventional work-up is the preferred option.


Only data from indirect comparisons are available from the accuracy review, and there is some uncertainity about whether the data defining the accuracy of PET/CT present its use as a replacement or as an adjunct to conventional work-up.


Based on the current model and given the limitations that are apparent in terms of limited availability of data, the result of the current analysis suggests that the use of PET/CT in the diagnosis of recurrent breast cancer in every woman suspected of having a recurrence is unlikely to be cost-effective given the current willingness-to-pay thresholds that are accepted in the UK by decision-making bodies such as the National Institute for Health and Clinical Excellence. Our modelling suggests that conventional work-up could be the most cost-effective diagnostic strategy given current data. Future studies need to secure robust cost data that can be verified from more than one source for the diagnostic tests involved in PET and PET/CT. Reliable and verifiable data on quality of life associated with this clinical condition are also crucial.


The National Institute for Health Research Health Technology Assessment programme.


Suggested citation:

Auguste P, Barton P, Hyde C, Roberts TE. An economic evaluation of positron emission tomography (PET) and positron emission tomography/computed tomography (PET/CT) for the diagnosis of breast cancer recurrence. Health Technol Assess 2011;15(18).

Declared competing interests of authors: none

The research reported in this issue of the journal was commissioned by the HTA programme as project number 08/34/02. The contractual start date was in December 2009. The draft report began editorial review in May 2010 and was accepted for publication in September 2010. As the funder, by devising a commissioning brief, the HTA programme specified the research question and study design. The authors have been wholly responsible for all data collection, analysis and interpretation, and for writing up their work. The HTA editors and publisher have tried to ensure the accuracy of the authors' report and would like to thank the referees for their constructive comments on the draft document. However, they do not accept liability for damages or losses arising from material published in this report.

The views expressed in this publication are those of the authors and not necessarily those of the HTA programme or the Department of Health.

© 2011, Crown Copyright.

Included under terms of UK Non-commercial Government License.

PMID: 21524363

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