@article {Phippen944, author = {Neil T. Phippen and Laura J. Havrilesky and Jason C. Barnett and Chad A. Hamilton and Michael P. Stany and William J. Lowery}, title = {Does Routine Posttreatment PET/CT Add Value to the Care of Women With Locally Advanced Cervical Cancer?}, volume = {26}, number = {5}, pages = {944--950}, year = {2016}, doi = {10.1097/IGC.0000000000000705}, publisher = {BMJ Specialist Journals}, 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.}, issn = {1048-891X}, URL = {https://ijgc.bmj.com/content/26/5/944}, eprint = {https://ijgc.bmj.com/content/26/5/944.full.pdf}, journal = {International Journal of Gynecologic Cancer} }