1. Overskrift her Navn på oplægsholder Navn på KU- enhed For at ændre ”Enhedens navn” og ”Sted og dato”: Klik i menulinjen, vælg ”Indsæt” > ”Sidehoved / Sidefod”. Indføj ”Sted og dato” i feltet for dato og ”Enhedens navn” i Sidefod PET/CT as a Cost Saver in Oncology Dream or Reality? BM Fischer MD, DMSci Dept of Clinical Physiology, Nuclear Medicine and PET Rigshospitalet, University of Copenhagen

2. Overskrift her Navn på oplægsholder Navn på KU- enhed For at ændre ”Enhedens navn” og ”Sted og dato”: Klik i menulinjen, vælg ”Indsæt” > ”Sidehoved / Sidefod”. Indføj ”Sted og dato” i feltet for dato og ”Enhedens navn” i Sidefod

3. What is so special about PET/CT? PET characteristics Very high sensitivity Micro dosing Quantitative Translational Whole body So much more than FDG…

4. June

5. October

6. June October May

7. DIAGNOSING – STAGING – RT PLANNING THERAPY EVALUATION FOLLOW-UP

16. Cancer expenditures Non-imaging: USD 30.6 billion PET 320 million Imaging 1.2 billion Yang & Czernin, JNM 2011;86S-92S Imaging constitutes a minor part of cancer care expenditures Imaging

17. Dinan et al, JAMA 2010;1625-31 – but outpaces the increase in total cancer costs

18. Dinan et al, JAMA 2010;1625-31 Increase in imaging cost mainly driven by PET

19. PET, Cost and survival among 51,374 Medicare beneficiares with lung cancer 1996- 2005 Dinan, J Thorac Onc 2014;512-18

20. PET, Cost and survival among 51,374 Medicare beneficiares with lung cancer 1996- 2005 Dinan, J Thorac Onc 2014;512-18 Increasing total health care costs  Increasing use of chemotherapy (not temporarily correlated with the use of PET)  Increase in costs associated with comorbidity

21. PET, Cost and survival among 51,374 Medicare beneficiares with lung cancer 1996- 2005 Dinan, J Thorac Onc 2014;512-18 Increasing total health care costs  Increasing use of chemotherapy (not temporarily correlated with the use of PET)  Increase in costs associated with comorbidity Significant increase in the use of PET  Stage-migration  Reduced rates of surgery and radiotherapy  Decreasing inpatient health care cost

22. Brief introduction to Health Economy

23. CUA - Cost Utility Analysis Compares alternative interventions on cost and effect adjusted for quality (quality of life) Standardized and validated interviews or questionnaires a prerequisite Enables broader comparison ICER, i.e. $/QALY

24. CEA - Cost Effectiveness Analysis Compares effectiveness (accuracy, survival) and costs between alternative interventions – i.e. EUR/correct diagnosis Most frequently applied method in health Only valid in direct comparison of different methods/treatment Based on a clinical trial or modeling

25. CBA - Cost Benefit Analysis Compares alternative interventions on cost and the value of an effect. Compare present value of benefit and present value of cost Rarely used in health sciences, but enables us to put a value on the benefit/effect and thus compare non- related interventions. What is better: a new scanner or a new bicycle road..

26. STAGING LUNG CANCER

27. Cost-Effectiveness Analysis of PET in Lung Cancer Verboom, Eur J Nucl Med Mol Imaging 2003;30:1444-9 Søgaard, Eur J Nucl Med Mol Imaging 2011;38:802-9

28. Cost-Effectiveness Analysis of PET in Lung Cancer Verboom, Eur J Nucl Med Mol Imaging 2003;30:1444-9 Søgaard, Eur J Nucl Med Mol Imaging 2011;38:802-9

29. Cost-Effectiveness Analysis of PET in Lung Cancer Verboom, Eur J Nucl Med Mol Imaging 2003;30:1444-9 Søgaard, Eur J Nucl Med Mol Imaging 2011;38:802-9

30. Model based cost-effectiveness analysis X10.000

31. THERAPY PLANNING & EVALUATION

32. Cost-effectiveness of FET-PET for treatment management in patients with recurrent high-grade glioma Courtesy of Dr. Ian Law Therapy planning

33. Cost-effectiveness of FET-PET for treatment management in patients with recurrent high-grade glioma Courtesy of Dr. Ian Law 2 months after radio- therapy Therapy planning

34. Cost-effectiveness of FET-PET for treatment management in patients with recurrent high-grade glioma Courtesy of Dr. Ian Law 2 months after radio- therapy Therapy planning

35. Cost-effectiveness of FET-PET for treatment management in patients with recurrent high-grade glioma Heinzel, JNM 2013;1217-1222 Treatment with bevacizumab and irinotecan

36. Cost-effectiveness of FET-PET for treatment management in patients with recurrent high-grade glioma Heinzel, JNM 2013;1217-1222 For diagnosing recurrence and estimation of therapy response: NNT=3 ICER = 5,725 €

37. Cost-effectiveness of FET-PET for treatment management in patients with recurrent high-grade glioma Heinzel, JNM 2013;1217-1222 For diagnosing recurrence and estimation of therapy response: NNT=3 ICER = 5,725 € Costs for therapy not included, but estimated at 8,000 €/ 4 week No estimation of survival nor QALY

38. THERAPY PLANNING & EVALUATION

39. MODEL-BASED CEA OF RADIATION THERAPY IN LUNG CANCER X50,000 CRT 60/70 Gy 2 Gy daily 42 days PET-ART 54-79 Gy 1.8 Gy twice daily 25 days Bongers, Int J Radiation Oncol Biol Phys 2015; 857-65

40. MODEL-BASED CEA OF RADIATION THERAPY IN LUNG CANCER X50,000 CRT 60/70 Gy 2 Gy daily 42 days PET-ART 54-79 Gy 1.8 Gy twice daily 25 days Relapse Adverse events Survival/LY QALY Costs Relapse Adverse events Survival/LY QALY Costs Bongers, Int J Radiation Oncol Biol Phys 2015; 857-65

41. Incremental Costs Incremental LY PET-ART vs CRT: €1360 / LY saved €1744 /QALY

43. No! But, the PET/CT is the tool that enables improved RT planning, increasing dose and tumour control

44. FOLLOW-UP

45. PET/CT for stratification of follow-up intensity after radical radiotherapy for head and neck cancer Standard cohort treated 2005-2007 PET stratified cohort 2009-2011 Routine clinical follow-up every 3 months CMR noCMRCR noCR Follow-up every 6 mo Time to detection of recurrence Treatment and survival Costs Shah, Oral Oncology 2015; 529-35

46. Standard cohort treated 2005-2007 PET stratified cohort 2009-2011 Routine clinical follow-up every 3 months in two years CMR noCMRCR noCR Follow-up every 6 mo Time to detection of recurrence: NS Treatment and survival: NS Costs: €1660 savings per patient Shah, Oral Oncology 2015; 529-35

47. Standard cohort treated 2005-2007 PET stratified cohort 2009-2011 Routine clinical follow-up every 3 months in two years CMR noCMRCR noCR Follow-up every 6 mo Time to detection of recurrence: NS Treatment and survival: NS Costs: €1660 savings per patient Shah, Oral Oncology 2015; 529-35

48. PET/CT as a Cost Saver in Oncology Dream or Reality? PET/CT is a valuable signpost with a –partially deserved- pricy reputation Used wisely PET/CT is the key to cost-effective improvements in the care of cancer patients and sometimes even a cost saver PET/CT can play a key role in the development and implementation of personalized medicine

49. PET/CT as a Cost Saver in Oncology Dream & Reality THANK YOU FOR YOUR ATTENTION