Cost-Utility of PET/CT Surveillance Post Achieving First Remission in Patients with Diffuse Large B-Cell Lymphoma: A Systematic Review

Objectives: To study the costs and utilities associated with the use of positron emission tomography-computed tomography (PET/CT) surveillance for the first remission. Methods: A systematic MEDLINE search was conducted by pairing relevant keywords to identify English language articles describing costs and utilities involved with the usage of PET/CT surveillance in patients with Diffused Large B Cell Lymphoma (DLBCL). Results: PET/CT resulted in similar medical costs along with similar clinical outcomes as compared to no surveillance (Korean won 2,499,689 vs 5,229,901, p<0.755). Additionally, in a Markov decision-analytic model with 2-year time horizon, PET/CT surveillance had a small but insignificant benefit over no surveillance in terms of qualityadjusted life years (QALYs) gained (CT, 0.020 QALYs; PET/CT, 0.025 QALYs). This led to high ICERs per QALY gained ($164,960- $168,750). Conclusions: As surveillance for the first remission with PET/CT is providing similar clinical and utility outcomes at a significantly high cost, we do not support routine surveillance for follow-up of DLBCL and suggest its usage should be adopted more wisely in patients with DLBCL.