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PET/CT could save millions in ID of transplant cases
Improved accuracy of PET/CT delivers dividends
A study out of Johns Hopkins Medical Institutions provides new evidence that fluorodeoxyglucose (FDG) — positron emission tomography/CT (PET/CT) is not only more accurate than CT, but it also could save the U.S. health care system $150 million per year if it was used, instead of CT, to identify which patients with relapsed diffuse large B-cell lymphoma (DLBCL) stand to benefit from stem cell transplants.
The study, which was presented at the recent Society of Nuclear Medicine conference, compared the cost efficacy of FDG-PET/CT and CT in DLBCL patients. Researchers found that PET/CT is better at predicting the clinical outcomes of stem cell transplants in these patients based on patient-specific molecular features.
"The main savings come from decreasing the use of stem cell transplants because PET/CT better identifies which patients are likely to clinically benefit," according to Daniel Mollura, MD, a fellow in the Division of Nuclear Medicine, Department of Radiology, at Johns Hopkins University School of Medicine in Baltimore, MD. Mollura was a co-investigator along with Yvette Kasamon, MD, an assistant professor of medicine and oncology, and Richard Wahl, MD, the director of nuclear medicine/PET, both also at Johns Hopkins University School of Medicine.
The standard of care has been to use CT to evaluate transplant candidates by assessing the response to chemotherapy based in changes in lymph node size. However, as PET/CT comes into more use, it's being used to assess response to therapy, not based on lymph node size criteria, but rather on whether there are abnormal signals that represent lymphoma cells with hyper-metabolic activity. "A small lymph node may be seen as normal on CT, but PET/CT measures the amount of labeled sugar or FDG uptake and visualizes whether the cells are behaving abnormally, so a small lymph node containing abnormal cells will appear bright on a PET scan and stand out from the rest of the surrounding normal tissue," says Mollura. "The effect of PET/CT is that it increases the sensitivity of detecting a cancer in comparison to CT."
To conduct their research, investigators collected national immunological data on DLBCL patients and financial data on the costs associated with stem cell transplants at Johns Hopkins Medical Institutions. Out of the nearly 19,000 DLBCL patients analyzed, investigators found that about half relapsed. Most of those patients (90%) were considered candidates for stem cell transplants, if their relapsed disease was sensitive to chemotherapy. Investigators found that 60% of the relapsed patients were chemo-sensitive according to CT, but about 20% of that group proved to be chemo-refractory on FDG-PET/CT scans.
Based on their analysis, investigators conclude that more than 1,000 stem cell transplants, at a cost of about $150,000 per transplant, are conducted every year that will not be beneficial because of CT-based risk-stratification that is less accurate than FDG-PET/CT. While CT is slightly less expensive to perform than PET/CT ($1,200 versus $1,400), the authors emphasize that the improved accuracy of PET/CT offers considerable savings.
"There is ongoing debate about how the United States health care system must trim expenditures. However, legislatures frequently focus on cutting costs without addressing the need to increase efficiency and the quality of health care," says Mollura. "It was important to demonstrate how medical imaging might improve efficiency by changing the use of health care resources to achieve better outcomes."