Cost-Effectiveness of Positron Emission Tomography/Computed Tomography (PET/CT) in the Initial N-Staging of Head–Neck Cancer and Comparison with CT and Magnetic Resonance Imaging (MRI)

The aim of the study was to evaluate the cost-effectiveness of PET/CT in the initial N-staging of head-neck cancer (HNC) and to compare it with alternative strategies using CT or MRI within the Greek National Healthcare System. A cohort of 100 clinically N0 (with no apparent metastatic cervical lymph nodes) HNC patients was simulated over a 10-year time horizon. Initially, a decision tree model was used to simulate the following three different imaging strategies for HNC staging: (a) whole-body FDG-PET/CT, (b) CT of the neck, chest, and abdomen ("CT"), and (c) MRI of the neck plus CT of the chest-abdomen ("MRI"). Subsequently, a Markov model was used to simulate transitions into the health states of recurrence and death. Epidemiological evidence, diagnostic accuracy rates, transition probabilities, and healthcare costs were obtained from the literature and official local tariffs. The estimated total costs per patient were EUR 128,729 for PET/CT, EUR 128,779 for MRI, and EUR 128,585 for CT. The corresponding life years (LYs) were 6.171 LYs for PET/CT, 6.170 LYs for MRI, and 6.170 LYs for CT, respectively. The analysis showed that PET/CT dominates MRI. The incremental cost-effectiveness ratio (ICER) of PET/CT vs. CT was estimated at EUR 144,984 per LY gained. All three imaging strategies had comparable health outcomes and costs, with PET/CT being an appropriate and efficient imaging modality because of its high diagnostic accuracy in the N-staging of HNC.