Molly T. Beinfeld MS, Abstract Co-Author: Nothing to Disclose

Eve Wittenberg PHD, Abstract Co-Author: Nothing to Disclose

G. Scott Gazelle MD, Presenter: Nothing to Disclose

To make preliminary estimates of the effectiveness (in life-years) and cost-effectiveness (in dollars per life-year) of whole-body CT (WBCT) screening.

We calculated the costs and effectiveness (in life-years) of one-time WBCT screening relative to no screening using a decision-analytic model. We assumed that any benefits from screening were due to earlier detection of disease and improved survival relative to routine care. In the model we included eight conditions: ovarian, pancreatic, lung, liver, kidney and colon cancer, abdominal aortic aneurysm, and coronary artery disease. Costs of the screening exam, follow-up tests, and patient management were estimated. The base-case analysis was performed for a hypothetical cohort of 500,000 50 year-old asymptomatic, self-referred men. In sensitivity analyses, the age and gender of the cohort was varied. Results were expressed in terms of dollars per life year gained.

Compared to routine care, WBCT screening provided minimal gains in life expectancy (0.0166 years or 6 days) at an average additional cost of $2,513 per individual, or an incremental cost-effectiveness ratio of $151,000 per life year gained. Most (90.8%) patients had at least one positive finding, but only 2.0% actually had disease. Management of patients with false positive tests accounted for 32.3% of total costs. The results were sensitive to the prevalence of disease, the effect of screening on stage of diagnosis, test specificity, and costs of follow-up for false positive tests.

Even with assumptions favorable to WBCT, implementation of one-time screens would not be cost-effective relative to currently funded medical interventions; follow-up for false positive tests would add a substantial financial burden to the healthcare system.

Beinfeld, M, Wittenberg, E, Gazelle, G, Cost-Effectiveness of Whole-Body CT Screening.  Radiological Society of North America 2004 Scientific Assembly and Annual Meeting, November 28 - December 3, 2004 ,Chicago IL. http://archive.rsna.org/2004/4411624.html