Cost-effectiveness of positron emission tomography-CT in the evaluation of cancer of unknown primary of the head and neck

Background. Positron emission tomography (PET)-CT is a useful diagnostic adjunct for cancer unknown primary (CUP) of the head and neck; however, the increased cost has not been justified with an economic evaluation in this patient population. Methods. A decision tree analysis was performed from the perspective of the third party payer. Primary outcome was cost per life year gained ($/LYG). The 2 comparative groups were: (1) PET-CT followed by panendoscopy versus (2) panendoscopy alone. Results. The incremental cost-effectiveness ratios for N1, N2, and N3 CUP were $369.83/LYG, $329.43/LYG, and $4900.28/LYG, respectively. The sensitivity analysis demonstrated a 96.8%, 97.1%, and 60.1% certainty that PET-CT is cost-effective for CUP with N1, N2, and N3 disease, respectively. Conclusion. The use of PET-CT in patients with N1 and N2 CUP is the cost-effective choice. The cost-effectiveness in N3 CUP is questionable and should be used on an individual case basis. (C) 2014 Wiley Periodicals, Inc.