Evaluating PET/CT's Role in Head-Neck Cancer Staging: Diagnostic Accuracy and Cost-Effectiveness

A Greek cost-effectiveness analysis shows that PET/CT delivers higher diagnostic accuracy and is marginally cost‑saving versus MRI for initial N‑staging of clinically N0 head and neck cancer.

The investigators used a decision‑analytic framework to compare whole‑body FDG‑PET/CT, neck CT (with chest/abdomen CT), and neck MRI (plus chest/abdomen CT) in a simulated cohort of 100 clinically N0 patients over a 10‑year horizon, reporting diagnostic accuracy, total costs per patient, and life years (LYs) gained as primary endpoints.

PET/CT showed superior sensitivity—around 80–85%—and slightly higher specificity than CT and MRI, with particular advantage in detecting small or normal‑sized nodes and disease in retropharyngeal and other complex anatomic regions. The metabolic information from PET/CT reduced equivocal findings that might otherwise prompt unnecessary radical lymphadenectomy or further imaging.

The economic model combined a decision tree with a Markov model to simulate downstream health states and to aggregate long‑term costs and life years (LYs) over 10 years. Inputs included test performance, treatment pathways triggered by true/false results, and costs. In the base case, PET/CT incurred EUR 128,729 per patient with 6.171 LYs versus MRI at EUR 128,779 with 6.170 LYs. Compared with CT, PET/CT produced an incremental cost-effectiveness ratio (ICER) of EUR 144,984 per LY gained.