Increased utilization of positron emission tomography/computed tomography (PET/CT) imaging and its economic impact for patients Diagnosed With Bladder Cancer: Beyond the Abstract

Widespread adoption of costlier advanced imaging modalities such as PET/CT with lack of well-documented superiority over conventional other imaging techniques can have a significant impact on the national health care system. Imaging techniques such as positron emission tomography–computed tomography (better known as PET-CT or PET/CT), magnetic resonance imaging (MRI), and computed tomography (CT) can improve preoperative staging and follow-up surveillance. Prior studies have explored the utility of PET/CT imaging in primary bladder cancer with limited evidence suggesting clinical superiority. Taking the above into account, current guidelines recommend CT and/or MRI as the preferred abdominal imaging modality in staging bladder cancer patients.

We examined the trends in use of imaging as well as costs associated with imaging within 12 months from diagnosis of bladder cancer.  A total of 36,855 patients aged 66 years or older diagnosed with clinical stage TI-IV, N0M0 bladder cancer from 2004 to 2011 were analyzed. In total, 24,240 (65.8%) patients received one of these three imaging modalities within 12 months after bladder cancer diagnosis: 1,291 (3.5%) PET/CT, 1,495 (4.1%) MRI, and 21,454 (58.2%) CT. Independent of clinical stage, there was marked increase in use of PET/CT throughout the study period (2011 v 2004: OR 17.55, 95% CI = 10.14-30.38, P<0.001). We also observed a greater use of PET/CT among female patients, residents in West region, patients diagnosed with hydronephrosis or high grade tumor, and patients who underwent surgery, chemotherapy, or radiation therapy.  

The mean incremental cost of PET/CT vs. CT and MRI was $1,040 and $612 (in 2016 dollars), respectively. The estimated national excess in health care costs for PET/CT imaging compared to less costlier conventional CT and MRI techniques was $11.6 million.

In summary, we assessed trends in use of PET/CT, MRI, and CT among bladder cancer patients. Our study revealed a significant shift in the type of imaging modality performed during the study period. Specifically, we observed marked 16-fold increased use of PET/CT regardless of clinical stage. This rapid adoption of PET/CT translated into excess national spending of approximately $11 million. These findings have important implications regarding health policy decision-making and the need for improved value-based bladder cancer care.

Written by: Stephen B. Williams, MD, The University of Texas Medical Branch

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