Is Long-Axial-Field-of-View PET/CT Cost-Effective? An International Health-Economic Analysis

Our aim is to assess the cost-effectiveness of long-axial-field-of-view (LAFOV) versus short-axial FOV (SAFOV) PET/CT systems using international data. Methods: Our model compares equipment and operational costs for a PET/CT center and investigates the effect of camera choice (SAFOV vs. LAFOV) and operational models. Variables include scanner, personnel, radiopharmaceuticals, and operational costs. Economic performance was measured as cost per scan per patient, the total maximum number of scans possible, and the incremental cost-effectiveness ratio. The willingness-to-pay threshold (WTPT) was taken as the cost of a PET/CT scan using the baseline scenario. Radiopharmaceutical requirements, radiation dose to staff and patients, and patient time were modeled. Results: An LAFOV system can examine as many patients per day (n = 36) as 2 SAFOV systems but requires fewer technologists (4.5 LAFOV vs. 6.8 SAFOV full-time equivalents) and lower activity (12.5 vs. 35.6 GBq/d), resulting in lower personnel doses (0.9 vs. 2.0 mSv/y). For all countries, LAFOV resulted in lowest per-patient scan costs. The most cost-ineffective method was the use of extended hours. Incremental cost-effectiveness ratio analysis strongly favored LAFOV for all countries, including low-income economies, with WTPT met for all jurisdictions. Net monetary benefit was highest for LAFOV. The minimum number of patients needed to meet WTPT for LAFOV was lowest in lower-income countries, suggesting that high throughput or high per-procedure income is not a prerequisite for cost-effective LAFOV usage. Conclusion: LAFOV was shown to facilitate higher patient throughput at lower per-patient and total lifetime operational costs and with lower radiopharmaceutical requirements. These data suggest that LAFOV systems are not just suited to well-resourced academic centers but also are an economically attractive solution for community and resource-limited settings.