Positron Emission Mammography (PEM) in the diagnosis of breast cancer: A systematic review and economic evaluation

Khosro Keshavarz; Mojtaba Jafari; Farhad Lotfi; Peivand Bastani; Mahmood Salesi; Farshid Gheisari; Mohsen Rezaei Hemami

doi:10.34171/mjiri.34.100

Positron Emission Mammography (PEM) in the diagnosis of breast cancer: A systematic review and economic evaluation

Med J Islam Repub Iran. 2020 Aug 18:34:100. doi: 10.34171/mjiri.34.100. eCollection 2020.

Authors

Khosro Keshavarz¹, Mojtaba Jafari², Farhad Lotfi¹, Peivand Bastani¹, Mahmood Salesi³, Farshid Gheisari^{4

5}, Mohsen Rezaei Hemami⁶

Affiliations

¹ Health Human Resources Research Center, School of Management and Medical Informatics, Shiraz University of Medical Sciences, Shiraz, Iran.
² Student Research Committee, Shiraz University of Medical Sciences, Shiraz, Iran.
³ Chemical Injuries Research Center, Systems Biology and Poisonings Institute, Baqiyatallah University of Medical Sciences, Tehran, Iran.
⁴ Faculty of Medicine, Shiraz University of Medical Sciences, Shiraz, Iran.
⁵ Ionizing and Non-Ionizing Radiation Protection Research Center, School of Paramedical Sciences, Shiraz University of Medical Sciences, Shiraz, Iran.
⁶ University of Exeter, PenTAG Health Technology Assessment, UK.

Abstract

Background: Positron Emission Mammography (PEM) is an imaging technique which is increasing focuses on imaging the chest instead of imaging the whole body. The aim of this study was to conduct a systematic review of the clinical efficacy and coste-ffectiveness of PEM technology, as compared with PET, as a diagnostic method used for breast cancer patients. Methods: The present study was a Health Technology Assessment (HTA), which was conducted via a systematic review of clinical efficacy and cost-effectiveness of the methods based on domestic evidence. To evaluate the efficacy of the PEM diagnostic method, as compared with PET, we used efficacy indices, including Sensitivity, Specificity, Accuracy, PPV, and NPV. The required data were collected through a meta-analysis of studies published in electronic databases from 1990 to 2016. In addition, direct costs in both methods were estimated and finally, a cost-effectiveness analysis was performed using the results of the study. Also, a one-way sensitivity analysis was performed to examine the effects of parameters' uncertainty in the model. In this study, we used STATA software to integrate the results of studies with similar parameters. Results: A total of 722 cases (N) were obtained from the five final studies. The results of the meta-analysis performed on the collected data showed that the two methods were identical in terms of the Specificity and PPV parameters. However, as to Sensitivity, NPV, and Accuracy parameters, the PEM method was superior to the PET for diagnosis of primary breast cancer. The total cost of using PEM and PET was $1737385.7 and $1940903.5, respectively, and the cost of a one-time scan (cost per unit) using PEM and PET devices was $86.82 and $157.63, respectively. As compared with the PET method, the use of the PEM diagnostic method for diagnosis of breast cancer was cost-effective in terms of all the five studied parameters (it was definitely cost-effective for four parameters and was also considered as cost-effective for another index, since ICER was below the threshold). Conclusion: The results showed that the use of PEM technology for the diagnosis of primary breast cancer is more cost-effective than PET technology; thus, due to the wide range of PET technology in different fields, it is recommended that this method should be used in other areas of priority.

Keywords: Breast cancer; HTA; Meta-analysis; PEM; PET.

Publication types

Review