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Does Routine Posttreatment PET/CT Add Value to the Care of Women With Locally Advanced Cervical Cancer?
  1. Neil T. Phippen, MD,
  2. Laura J. Havrilesky, MD,
  3. Jason C. Barnett, MD,
  4. Chad A. Hamilton, MD,
  5. Michael P. Stany, MD and
  6. William J. Lowery, MD
  1. * Gynecologic Oncology Service, Department of Obstetrics and Gynecology, Murtha Cancer Center, Walter Reed National Military Medical Center, Bethesda, MD;
  2. Department of Defense Gynecologic Cancer Center of Excellence, Women’s Health Integrated Research Center at Inova Health System, Annandale, VA;
  3. Division of Gynecologic Oncology, Duke Cancer Center, Durham, NC; and
  4. § Division of Gynecologic Oncology, Department of Obstetrics and Gynecology, San Antonio Military Medical Center, Fort Sam Houston, TX.
  1. Address correspondence and reprint requests to Neil T. Phippen, MD, Gynecologic Oncology Cancer Center of Excellence, Walter Reed National Military Medical Center, 8901 Rockville Pike, Bethesda, MD 20889. E-mail: neil.phippen{at}icloud.com.

Abstract

Objectives The aim of this study was to determine the necessary reduction in recurrence rate that would make postchemoradiation positron emission tomography (PET)/computed tomography (CT) to direct completion hysterectomy for locally advanced cervical cancer (LACC) cost-effective.

Methods A decision model evaluated costs and recurrence rates of 2 posttreatment surveillance strategies in LACC: (1) routine surveillance without PET/CT and (2) PET/CT after 3 months to triage to completion hysterectomy. Incremental cost-effectiveness ratios were expressed in dollars per additional cancer recurrence avoided. Model parameters included expected rates of recurrence using each strategy, true- and false-positive rates of posttreatment PET/CT, and major complications of completion hysterectomy. From published data, we modeled an LACC baseline recurrence rate of 32%, PET/CT false-positive rate of 33%, and false-negative rate of 19%. We assumed that PET/CT revealed persistent local cervical cancer in 16% and progressive or distant disease in 6%. Costs of PET/CT, hysterectomy, and treatment for recurrence were based on Medicare reimbursements. A 50% salvage rate with hysterectomy was assumed and varied in sensitivity analysis.

Results Routine use of PET/CT to direct completion hysterectomy was associated with a higher average cost ($16,579 vs $15,450) and a lower recurrence rate (26% vs 32%). The incremental cost-effectiveness ratio of PET was $20,761 per recurrence prevented. When the probability of recurrence after hysterectomy dropped to 25% or less, PET/CT was a dominant strategy.

Conclusions Routine use of PET/CT to determine which patients may benefit from a completion hysterectomy after chemoradiation for LACC has the potential to be highly cost-effective.

  • Cervical cancer surveillance
  • PET/CT
  • Cost-effectiveness
  • Completion hysterectomy

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Footnotes

  • The authors declare no conflicts of interest.

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