Cost-Effectiveness of ^sup 99m^Tc-Sestamibi in Predicting Response to Chemotherapy in Patients with Lung Cancer: Systematic Review and Meta-Analysis

Multidrug resistance (MDR) is a major problem in lung cancer. ^sup 99m^Tc-methoxyisobutylisonitrile (^sup 99m^Tc-MIBI) has been demonstrated to be a noninvasive marker for the diagnosis of MDR-related P glycoprotein and MDR-associated protein expression in various solid tumors. Studies have shown that ^sup 99m^Tc-MIBI could play a significant role in the management of lung cancer; for example, it could be used in the selection of patients for chemotherapy or radiotherapy or in combined protocols before the start of treatment. Accurate selection of chemosensitive patients with ^sup 99m^Tc-MIBI would result not only in effective treatment of patients but also in significant cost savings for health care providers. There is increasing pressure on health care providers to consider costs in medical decision making, particularly in the last decade, as several economic evaluations have appeared in the medical literature. The aims of this study were to undertake a systematic review of the performance of ^sup 99m^Tc-MIBI imaging in the assessment of treatment resistance in lung cancer and to use the findings of the review in a decision tree analysis of the potential cost-effectiveness of ^sup 99m^Tc-MIBI imaging in selecting lung cancer patients for chemotherapy. Methods: This study included a systematic review of the literature and a meta-analysis together with a cost-effectiveness analysis of studies with a decision tree analysis model. Results: Analysis of the studies revealed that the overall sensitivity of ^sup 99m^Tc-MIBI in identifying responders to chemotherapy was 94%, the specificity was 90%, and the accuracy was 92%. The sensitivity analysis revealed an incremental cost-effectiveness ratio of greater than £30,000 (~$42,900) for the strategy of treating all patients to recover the small loss of life expectancy (7.5 d) associated with the use of ^sup 99m^Tc-MIBI to preselect patients for chemotherapy. Conclusion: ^sup 99m^Tc-MIBI SPECT can accurately predict which patients with lung cancer will respond to chemotherapy. The use of ^sup 99m^Tc-MIBI to preselect patients for chemotherapy has the potential to yield significant cost savings in the health care system without a significant loss of life expectancy for patients. [PUBLICATION ABSTRACT]