Cost-Effective and Strategic Planning for Cancer Management in India: A Comparative Study of PET/CT and CT Imaging

Aim: The aim of the study is to analyze the cost-effectiveness of positron emission tomography/computed tomography (PET/ CT) and computed tomography(CT) for cancer management in India, offering an economic evaluation to address healthcare disparities and inform strategic planning. A cost-effectiveness model was developed to compare PET/CT and CT in cancer management, providing policymakers and healthcare providers with data to support informed decisions, optimize resource allocation, and enhance cancer care efficiency in India. Methods: We used a probabilistic and deterministic Markov model which will assess the cost-effectiveness of PET/CT from a societal perspective over 5, 10 years, and a lifetime. Direct medical, non-medical, and indirect costs were calculated and reported with means, standard errors, and distribution types. Costs and quality-adjusted life-years (QALYs) were discounted at 3% annually. PET/CT unit data across Indian states were mapped against the cancer burden. Results: Over periods of 5, 10 years, and a lifetime, the model demonstrated PET/CT gains of 4.19, 6.42, and 6.99 QALYs, respectively. The incremental cost-effectiveness ratio (ICER) for PET/CT in comparison to CT was 617, 1,783, and 2,337 for these respective time frames. The probability sensitivity analysis (PSA) results were similar to the base-case lifetime ICER. Conclusion: This is the first Indian study on PET/CT capacity planning, utilizing evidence-based data, which indicates the need for one cyclotron for every 67 million individuals and one PET/CT unit for every 3.562 million individuals. Setting up a PET/CT facility without a cyclotron incurs a cost of INR 17.08 Cr (USD 2,339,048.75), whereas the expense for a cyclotron is INR 58.63 Cr (USD 8,026,734.1).