{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,8,24]],"date-time":"2026-08-24T20:10:35Z","timestamp":1787602235643,"version":"build-2736575974"},"reference-count":23,"publisher":"Wiley","issue":"4","license":[{"start":{"date-parts":[[2013,12,3]],"date-time":"2013-12-03T00:00:00Z","timestamp":1386028800000},"content-version":"vor","delay-in-days":0,"URL":"http:\/\/onlinelibrary.wiley.com\/termsAndConditions#vor"}],"funder":[{"name":"National Institute for Health Research Health Technology Assessment Programme","award":["9\/29\/02"],"award-info":[{"award-number":["9\/29\/02"]}]}],"content-domain":{"domain":["obgyn.onlinelibrary.wiley.com"],"crossmark-restriction":true},"short-container-title":["BJOG"],"published-print":{"date-parts":[[2014,3]]},"abstract":"<jats:sec><jats:title>Objective<\/jats:title><jats:p>To undertake a cost\u2010effectiveness analysis that compares positron emission tomography \u2013 computed tomography (PET\u2010CT) imaging plus standard practice with standard practice alone in the diagnosis of recurrent or persistent cervical cancer during routine surveillance and follow\u2010up of women who have previously been diagnosed and treated.<\/jats:p><\/jats:sec><jats:sec><jats:title>Design<\/jats:title><jats:p>Model\u2010based economic evaluation using data from a systematic review, supplemented with data from other sources, and taking a <jats:styled-content style=\"fixed-case\">UK N<\/jats:styled-content>ational <jats:styled-content style=\"fixed-case\">H<\/jats:styled-content>ealth <jats:styled-content style=\"fixed-case\">S<\/jats:styled-content>ervice (<jats:styled-content style=\"fixed-case\">NHS<\/jats:styled-content>) perspective.<\/jats:p><\/jats:sec><jats:sec><jats:title>Setting<\/jats:title><jats:p>Secondary Care in England.<\/jats:p><\/jats:sec><jats:sec><jats:title>Population<\/jats:title><jats:p>Women at least 3\u00a0months after the completion of treatment, with either recurrent or persistent cervical cancer.<\/jats:p><\/jats:sec><jats:sec><jats:title>Methods<\/jats:title><jats:p>A state transition (<jats:styled-content style=\"fixed-case\">M<\/jats:styled-content>arkov) model was developed using <jats:sc>TreeAge<\/jats:sc>\u00a0<jats:sc>Pro<\/jats:sc>\u00a02011. The structure of the model was informed by the reviews of the trials and clinical input. In the model, two diagnostic strategies were examined. A one\u2010way sensitivity analysis, probabilistic sensitivity analysis, and a value of information analysis were also carried out.<\/jats:p><\/jats:sec><jats:sec><jats:title>Main outcome measures<\/jats:title><jats:p>Cost\u2010effectiveness based on incremental cost per quality\u2010adjusted life year (<jats:styled-content style=\"fixed-case\">QALY<\/jats:styled-content>).<\/jats:p><\/jats:sec><jats:sec><jats:title>Results<\/jats:title><jats:p>Adding <jats:styled-content style=\"fixed-case\">PET<\/jats:styled-content>\u2013<jats:styled-content style=\"fixed-case\">CT<\/jats:styled-content> to the current treatment strategy of clinical examination and scanning [magnetic resonance imaging (<jats:styled-content style=\"fixed-case\">MRI<\/jats:styled-content>) and\/or <jats:styled-content style=\"fixed-case\">CT<\/jats:styled-content> scan] during the routine surveillance and follow\u2010up of women with recurrent or persistent cervical cancer is significantly more costly, with only a minimal increase in effectiveness. The incremental cost\u2010effectiveness ratio (<jats:styled-content style=\"fixed-case\">ICER<\/jats:styled-content>) for the strategy of <jats:styled-content style=\"fixed-case\">PET<\/jats:styled-content>\u2013<jats:styled-content style=\"fixed-case\">CT<\/jats:styled-content> as an adjunct to the standard treatment strategy that included clinical examination, <jats:styled-content style=\"fixed-case\">MRI<\/jats:styled-content>, and\/or <jats:styled-content style=\"fixed-case\">CT<\/jats:styled-content> scan, compared with the usual treatment alone, was over \u00a31\u00a0million per <jats:styled-content style=\"fixed-case\">QALY<\/jats:styled-content>.<\/jats:p><\/jats:sec><jats:sec><jats:title>Conclusion<\/jats:title><jats:p>The results of the current analysis suggest that use of <jats:styled-content style=\"fixed-case\">PET<\/jats:styled-content>\u2013<jats:styled-content style=\"fixed-case\">CT<\/jats:styled-content> in the diagnosis of recurrent or persistent cervical cancer is not cost\u2010effective. Current guidelines recommending imaging using <jats:styled-content style=\"fixed-case\">PET<\/jats:styled-content>\u2013<jats:styled-content style=\"fixed-case\">CT<\/jats:styled-content> as a diagnostic or surveillance tool need to be reconsidered in light of these results. This study did not specifically investigate the use of <jats:styled-content style=\"fixed-case\">PET<\/jats:styled-content>\u2013<jats:styled-content style=\"fixed-case\">CT<\/jats:styled-content> in women with symptoms and radiological suspicion of recurrence where exenteration was considered. More research in that specific area is required.<\/jats:p><\/jats:sec>","DOI":"10.1111\/1471-0528.12460","type":"journal-article","created":{"date-parts":[[2013,12,3]],"date-time":"2013-12-03T05:46:45Z","timestamp":1386049605000},"page":"464-476","update-policy":"https:\/\/doi.org\/10.1002\/crossmark_policy","source":"Crossref","is-referenced-by-count":35,"title":["Evaluating <scp>PET<\/scp>\u2013<scp>CT<\/scp> in routine surveillance and follow\u2010up after treatment for cervical cancer: a cost\u2010effectiveness analysis"],"prefix":"10.1111","volume":"121","author":[{"given":"P","family":"Auguste","sequence":"first","affiliation":[{"name":"Health Economics Unit University of Birmingham Birmingham UK"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"P","family":"Barton","sequence":"additional","affiliation":[{"name":"Health Economics Unit University of Birmingham Birmingham UK"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"C","family":"Meads","sequence":"additional","affiliation":[{"name":"Centre for Primary Care and Public Health Bart's and The London School of Medicine and Dentistry Queen Mary University of London London UK"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"C","family":"Davenport","sequence":"additional","affiliation":[{"name":"Unit of Public Health Epidemiology and Biostatistics University of Birmingham Birmingham UK"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"S","family":"Ma\u0142ysiak","sequence":"additional","affiliation":[{"name":"Arcana Institute Krakow Poland"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"M","family":"Kowalska","sequence":"additional","affiliation":[{"name":"Arcana Institute Krakow Poland"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"A","family":"Zapalska","sequence":"additional","affiliation":[{"name":"Arcana Institute Krakow Poland"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"P","family":"Guest","sequence":"additional","affiliation":[{"name":"Queen Elizabeth Medical Centre University Hospitals Birmingham NHS Foundation Trust Queen Elizabeth Hospital Birmingham UK"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"P","family":"Martin\u2010Hirsch","sequence":"additional","affiliation":[{"name":"Lancashire Teaching Hospitals NHS Trust Royal Preston Hospital Preston UK"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"E","family":"Borowiack","sequence":"additional","affiliation":[{"name":"Arcana Institute Krakow Poland"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"K","family":"Khan","sequence":"additional","affiliation":[{"name":"Centre for Primary Care and Public Health Bart's and The London School of Medicine and Dentistry Queen Mary University of London London UK"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"S","family":"Sundar","sequence":"additional","affiliation":[{"name":"Pan\u2010Birmingham Gynaecological Cancer Centre City Hospital and School of Cancer Sciences University of Birmingham Birmingham UK"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"T","family":"Roberts","sequence":"additional","affiliation":[{"name":"Health Economics Unit University of Birmingham Birmingham UK"}],"role":[{"vocabulary":"crossref","role":"author"}]}],"member":"311","published-online":{"date-parts":[[2013,12,3]]},"reference":[{"key":"e_1_2_10_2_1","doi-asserted-by":"publisher","DOI":"10.1002\/ijc.25516"},{"key":"e_1_2_10_3_1","unstructured":"Cancer Research UK.Cervical Cancer \u2013 UK Incidence statistics.2012. 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