Year: 2006
Type: dissertation
Abstract: Introduction and outline of the thesis 1Chapter 1 after PET and post hoc clinical assessment to grade the usefulness in diagnostic understanding and choice of therapy. ModellingTo fully assess a new diagnostic technology, the evaluation must assess test performance, the impact of the test on decision making and clinical outcomes, such as morbidity and mortality as well as the value of substitution and cost-effectiveness of a new diagnostic tool.Several strategies can be reconstructed to evaluate the value of 18 FDG PET.An advantage of a modeling approach is the possibility to vary the level of substitution of PET in the diagnostic work-up process and its consequent impact on the costs.By using clinical data the number of assumptions can be limited.To answer the question of the position of 18 FDG PET within the diagnostic procedures for NSCLC, several study designs can be considered: 18 FDG PET on top of regular staging, 18 FDG PET before invasive staging or 18 FDG PET in front of the staging process.Chapter 6 shows a cost modelling approach of 18 FDG PET in NSCLC.Consequently, these findings have been used in the design of a randomised trial.The question if 18 FDG PET could reduce the number of unnecessary thoracotomies was addressed in the PLUS trial [29] where the addition of 18 FDG PET before surgery (after conventional work-up) resulted in a prevention of unnecessary thoracotomies in one out of five patients.However it still remains to be determined whether the use of 18 FDG PET could replace conventional work-up (value of substitution) and shorten the work-up period without losing accuracy.In Chapter 7 we describe our randomised controlled trial of PET immediately after first presentation of patients with (suspected) NSCLC compared to the traditional strategy in routine clinical setting.
Author: Gerarda J.M. Herder
Language: English
Subfield: Pulmonary and Respiratory Medicine
Field: Medicine
Domain: Health Sciences
Open Access status: green
OpenAlex ID: W1565751787