PET-CT in Esophageal Cancer Management: A Cost Effectiveness Analysis Study


  • Nor Aniza Azmi Universiti Teknologi MARA (UiTM)
  • Hairil Rashmizal Abdul Razak Universitiy Putra Malaysia
  • Sobhan Vinjamuri Royal Liverpool University Hospital



The present investigation deals with the assessment of clinicians perceived views on the impact of PET-CT in esophageal cancer management from practicality, clinical efficacy and cost –effectiveness point of views. Review of publication and retrospective data to develop and carry out a decision making model-based economic evaluation to investigate the relative cost-effectiveness of PET/CT in esophageal cancer management staging compared with conventional pathway. Clinicians identified from patient medical records included in the survey. Retrospective analysis of patient data from 2001-2008 taken from esophageal cancer patient medical records and North West Cancer Intelligence Services (NWCIS) database. A decision tree was developed using TREEAGE software. The results of the cost-effectiveness analysis are presented in terms of the incremental cost-effectiveness ratios (ICERs). PET compared with conventional work-up results for ICER for the strategy estimated at £28,460 per QALY; PET/CT compared with PET for ICER was £ 32,590 per QALY; and the ICER for PET/CT combined with conventional work-up versus PET/CT was £ 44,118. The package become more expensive with each additional diagnostic test added to PET and more effective in terms of QALYs gained. The conventional work-up is the preferred options as probabilistic sensitivity analysis shows at a willingness-to-pay threshold of £ 20,000 per QALY. Result of the current analysis suggests that the use of PET/CT in the diagnosis of esophageal cancer is unlikely to be cost-effective given the current willingness-to-pay thresholds that are accepted in the United Kingdom by decision-making bodies such as the National Institute for Health and Clinical Excellence. 

Author Biographies

Nor Aniza Azmi, Universiti Teknologi MARA (UiTM)

Department of Medical Imaging, Faculty of Health Sciences

Hairil Rashmizal Abdul Razak, Universitiy Putra Malaysia

Faculty of Medicine & Health Sciences

Sobhan Vinjamuri, Royal Liverpool University Hospital

Department of Nuclear Medicine