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.

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