Abstract
Background and objectives: Metabolic imaging improves cancer program resolutivity and was not available in public healthcare Brazil. Patients with newly diagnosed Hodgkin’s lymphoma (HL) were consecutively enrolled in two centers, one in each Brazil and Italy, for this prospective trial to evaluate the costeffectiveness of fluorine-18 (18F)-fluoro-2-deoxyD-glucose-positron emission tomography (FDGPET) scan in initial staging of patients with HL. Methods: All 210 patients (120 Brazilian and 90 Italian) were staged with conventional clinical staging (CCS) methods, including computed tomography (CT), bone marrow biopsy (BMB), and laboratory tests. Patients were also submitted to metabolic staging (MS) with whole-body FDG-PET scan before the beginning of treatment. A standard of reference for staging was determined with all staging procedures, histologic examination, and follow-up examinations. The accuracy of the CCS was compared with the MS. Local unit costs of procedures and tests were evaluated. Incremental cost-effectiveness ratio (ICER) was calculated for both strategies. Results: In the 210 patients with HL[1], two thirds of the Brazilian cases were advanced (stages III and IV were 77 (64.2%) vs. 32 (35.5%) amid the Italians). The sensitivity for initial staging of FDG-PET was higher than that of CT and BMB in initial staging #HTAiTokyo2016 Posters 159 (97.9% vs. 87.3%; P Conclusions: Currently, Brazilian lymphomas are detected latter than in Italy. FDG-PET is more accurate than CT and BMB in HL staging. Given observed probabilities, FDG-PET is highly cost-effective in the public healthcare program in Brazil. Although limited to one center at each country, these results were further corroborated by other studies[2]. HTA Impact: The plenary of the Public Healthcare System Technology Incorporation National Commission, CONITEC/ Brazilian Health Ministry, endorsed these results and listed the PET/CT. Barriers for early detection of lymphomas were prioritized for studies financing. Moreover, this collaboration formed basis for further studies and international data sharing[3,4]. References: 1: Cerci JJ, Trindade E, Buccheri V, Fanti S, Coutinho AM, Zanoni L, Linardi CC, Celli M, Delbeke D, Pracchia LF, Pitela FA, Soares J Jr, Zinzani PL, Meneghetti JC. Consistency of FDG-PET accuracy and cost-effectiveness in initial staging of patients with Hodgkin lymphoma across jurisdictions. Clin Lymphoma Myeloma Leuk. 2011 Aug;11(4):314-20. doi: 10.1016/j.clml.2011.06.006. PubMed PMID: 21816369. 2: Abou-Nassar KE, Vanderplas A, Friedberg JW, Abel GA, Niland J, Rodriguez MA, Czuczman MS, Millenson M, Crosby A, Gordon LI, Zelenetz AD, Kaminski M, Lacasce AS. Patterns of use of 18-fluoro-2-deoxy-D-glucose positron emission tomography for initial staging of grade 1-2 follicular lymphoma and its impact on initial treatment strategy in the National Comprehensive Cancer Network Non-Hodgkin Lymphoma Outcomes database. Leuk Lymphoma. 2013 Oct;54(10):2155- 62. doi: 10.3109/10428194.2013.770151. Epub 2013 Feb 25. PubMed PMID: 23343180. 3: Carr R, Fanti S, Paez D, Cerci J, Györke T, Redondo F, Morris TP, Meneghetti C, Auewarakul C, Nair R, Gorospe C, Chung JK, Kuzu I, Celli M,
