Impact of 18FFDG-PET/CT and Laparoscopy in Staging of Locally Advanced Gastric Cancer: A Cost Analysis in the Prospective Multicenter PLASTIC-Study

Cas de Jongh; Miriam P van der Meulen; Emma C Gertsen; Hylke J F Brenkman; Johanna W van Sandick; Mark I van Berge Henegouwen; Suzanne S Gisbertz; Misha D P Luyer; Grard A P Nieuwenhuijzen; Jan J B van Lanschot; Sjoerd M Lagarde; Bas P L Wijnhoven; Wobbe O de Steur; Henk H Hartgrink; Jan H M B Stoot; Karel W E Hulsewe; Ernst Jan Spillenaar Bilgen; Marc J van Det; Ewout A Kouwenhoven; Freek Daams; Donald L van der Peet; Nicole C T van Grieken; Joos Heisterkamp; Boudewijn van Etten; Jan-Willem van den Berg; Jean-Pierre Pierie; Hasan H Eker; Annemieke Y Thijssen; Eric J T Belt; Peter van Duijvendijk; Eelco Wassenaar; Kevin P Wevers; Lieke Hol; Frank J Wessels; Nadia Haj Mohammad; Geert W J Frederix; Richard van Hillegersberg; Peter D Siersema; Erik Vegt; Jelle P Ruurda; PLASTIC Study Group

doi:10.1245/s10434-024-15103-4

Impact of ^18FFDG-PET/CT and Laparoscopy in Staging of Locally Advanced Gastric Cancer: A Cost Analysis in the Prospective Multicenter PLASTIC-Study

Ann Surg Oncol. 2024 Jun;31(6):4005-4017. doi: 10.1245/s10434-024-15103-4. Epub 2024 Mar 25.

Authors

Cas de Jongh¹, Miriam P van der Meulen², Emma C Gertsen¹, Hylke J F Brenkman¹, Johanna W van Sandick³, Mark I van Berge Henegouwen^{4

5}, Suzanne S Gisbertz^{4

5}, Misha D P Luyer⁶, Grard A P Nieuwenhuijzen⁶, Jan J B van Lanschot⁷, Sjoerd M Lagarde⁷, Bas P L Wijnhoven⁷, Wobbe O de Steur⁸, Henk H Hartgrink⁸, Jan H M B Stoot⁹, Karel W E Hulsewe⁹, Ernst Jan Spillenaar Bilgen¹⁰, Marc J van Det¹¹, Ewout A Kouwenhoven¹¹, Freek Daams^{5

12}, Donald L van der Peet^{5

12}, Nicole C T van Grieken^{5

12}, Joos Heisterkamp¹³, Boudewijn van Etten¹⁴, Jan-Willem van den Berg¹⁴, Jean-Pierre Pierie¹⁵, Hasan H Eker¹⁵, Annemieke Y Thijssen¹⁶, Eric J T Belt¹⁶, Peter van Duijvendijk¹⁷, Eelco Wassenaar¹⁷, Kevin P Wevers¹⁸, Lieke Hol¹⁹, Frank J Wessels¹, Nadia Haj Mohammad¹, Geert W J Frederix², Richard van Hillegersberg¹, Peter D Siersema²⁰, Erik Vegt^{3

7}, Jelle P Ruurda²¹; PLASTIC Study Group

Affiliations

¹ Department of Surgery, Medical Oncology and Radiology, University Medical Center (UMC) Utrecht, Utrecht, The Netherlands.
² Julius Center for Health Sciences and Primary Care, UMC Utrecht, Utrecht, The Netherlands.
³ Surgery and Nuclear Medicine Department, The Netherlands Cancer Institute-Antoni van Leeuwenhoek, Amsterdam, The Netherlands.
⁴ Surgery Department, Amsterdam UMC, Location University of Amsterdam, Amsterdam, The Netherlands.
⁵ Surgery and Pathology Department, Cancer Center Amsterdam, Amsterdam, The Netherlands.
⁶ Surgery Department, Catharina Hospital Eindhoven, Eindhoven, The Netherlands.
⁷ Surgery and Nuclear Medicine Department, Erasmus Medical Center UMC Rotterdam, Rotterdam, The Netherlands.
⁸ Surgery Department, Leiden UMC, Leiden, The Netherlands.
⁹ Surgery Department, Zuyderland MC, Sittard-Geleen, The Netherlands.
¹⁰ Surgery Department, Rijnstate Hospital, Arnhem, the Netherlands.
¹¹ Surgery Department, ZGT Hospital, Almelo, The Netherlands.
¹² Surgery and Pathology Department, Location Vrije University, Amsterdam UMC, Amsterdam, The Netherlands.
¹³ Surgery Department, Elisabeth Twee-Steden Hospital, Tilburg, The Netherlands.
¹⁴ Surgery Department, UMC Groningen, Groningen, The Netherlands.
¹⁵ Surgery Department, Medical Center Leeuwarden, Leeuwarden, The Netherlands.
¹⁶ Gastroenterology Department, Albert Schweitzer Hospital, Dordrecht, The Netherlands.
¹⁷ Surgery Department, Gelre Hospitals, Apeldoorn, The Netherlands.
¹⁸ Surgery Department, Isala Hospital, Zwolle, The Netherlands.
¹⁹ Gastroenterology Department, Maasstad Hospital, Rotterdam, The Netherlands.
²⁰ Gastroenterology and Hepatology Department, Erasmus MC - University Medical Center, Rotterdam, Rotterdam, The Netherlands.
²¹ Department of Surgery, Medical Oncology and Radiology, University Medical Center (UMC) Utrecht, Utrecht, The Netherlands. [email protected].

Abstract

Background: Unnecessary D2-gastrectomy and associated costs can be prevented after detecting non-curable gastric cancer, but impact of staging on treatment costs is unclear. This study determined the cost impact of ¹⁸F-fluorodeoxyglucose positron emission tomography/computed tomography (^18FFDG-PET/CT) and staging laparoscopy (SL) in gastric cancer staging.

Materials and methods: In this cost analysis, four staging strategies were modeled in a decision tree: (1) ^18FFDG-PET/CT first, then SL, (2) SL only, (3) ^18FFDG-PET/CT only, and (4) neither SL nor ^18FFDG-PET/CT. Costs were assessed on the basis of the prospective PLASTIC-study, which evaluated adding ^18FFDG-PET/CT and SL to staging advanced gastric cancer (cT3-4 and/or cN+) in 18 Dutch hospitals. The Dutch Healthcare Authority provided ^18FFDG-PET/CT unit costs. SL unit costs were calculated bottom-up. Gastrectomy-associated costs were collected with hospital claim data until 30 days postoperatively. Uncertainty was assessed in a probabilistic sensitivity analysis (1000 iterations).

Results: ^18FFDG-PET/CT costs were €1104 including biopsy/cytology. Bottom-up calculations totaled €1537 per SL. D2-gastrectomy costs were €19,308. Total costs per patient were €18,137 for strategy 1, €17,079 for strategy 2, and €19,805 for strategy 3. If all patients undergo gastrectomy, total costs were €18,959 per patient (strategy 4). Performing SL only reduced costs by €1880 per patient. Adding ^18FFDG-PET/CT to SL increased costs by €1058 per patient; IQR €870-1253 in the sensitivity analysis.

Conclusions: For advanced gastric cancer, performing SL resulted in substantial cost savings by reducing unnecessary gastrectomies. In contrast, routine ^18FFDG-PET/CT increased costs without substantially reducing unnecessary gastrectomies, and is not recommended due to limited impact with major costs.

Trial registration: NCT03208621. This trial was registered prospectively on 30-06-2017.

Keywords: Costs; Gastrectomy; Gastric cancer; Laparoscopy; Positron emission tomography; Staging.

Publication types

Multicenter Study

MeSH terms

Cost-Benefit Analysis
Costs and Cost Analysis
Female
Fluorodeoxyglucose F18* / economics
Follow-Up Studies
Gastrectomy* / economics
Humans
Laparoscopy* / economics
Laparoscopy* / methods
Male
Neoplasm Staging*
Positron Emission Tomography Computed Tomography* / economics
Positron Emission Tomography Computed Tomography* / methods
Prognosis
Prospective Studies
Radiopharmaceuticals* / economics
Stomach Neoplasms* / diagnostic imaging
Stomach Neoplasms* / economics
Stomach Neoplasms* / pathology
Stomach Neoplasms* / surgery

Substances

Fluorodeoxyglucose F18
Radiopharmaceuticals

Associated data

ClinicalTrials.gov/NCT03208621

Grants and funding

843004103/ZONMW_/ZonMw/Netherlands