Abstract
To date, the use of structural MR imaging (including contrast-enhanced and T2-weighted or fluid-attenuated inversion recovery-weighted images) is the standard method to diagnose tumor progression and to assess antiangiogenic treatment effects. However, several studies have suggested that O-(2-(18)F-fluoroethyl)-L-tyrosine ((18)F-FET) PET adds valuable clinical information to the information derived from structural MR imaging alone. We evaluated the effectiveness and cost-effectiveness of the addition of (18)F-FET PET to structural MR imaging for the management of treatment with bevacizumab and irinotecan (BEV/IR) in patients with recurrent high-grade glioma compared with MR imaging alone from the perspective of the German Statutory Health Insurance. METHODS: To evaluate the incremental cost-effectiveness of the additional use of (18)F-FET PET, a decision tree model was used. Effectiveness of (18)F-FET PET was defined as correct identification of both tumor progression before BEV/IR treatment initiation and BEV/IR treatment response and was evaluated for the combination of (18)F-FET PET and MR imaging compared with MR imaging alone. Costs were estimated for a baseline scenario and for a more expensive scenario. The robustness of the results was tested using deterministic and probabilistic sensitivity analyses. RESULTS: The use of (18)F-FET PET resulted in a number needed to diagnose of 2.4, that is, 3 additional patients have to be diagnosed to avoid 1 wrong diagnosis. The incremental cost-effectiveness ratio of (18)F-FET PET/MR imaging compared with MR imaging alone was euro5,725 (euro1 approximately $1.30) for the baseline scenario and euro8,145 for the more expensive scenario per additional correct diagnosis. The probabilistic sensitivity analysis confirmed the robustness of the results. CONCLUSION: The model suggests that the additional use of (18)F-FET PET in the management of patients with recurrent high-grade glioma treated with BEV/IR may be cost-effective. Integration of (18)F-FET PET has the potential to avoid overtreatment and corresponding costs, as well as unnecessary side effects to the patient.
Original language | English |
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Pages (from-to) | 1217-1222 |
Number of pages | 6 |
Journal | Journal of Nuclear Medicine |
Volume | 54 |
Issue number | 8 |
DOIs | |
Publication status | Published - Aug 2013 |
Keywords
- F-18-FET PET
- cost-effectiveness analysis
- recurrent glioma
- decision tree model
- POSITRON-EMISSION-TOMOGRAPHY
- MALIGNANT GLIOMA
- CEREBRAL GLIOMAS
- CLINICAL-APPLICATIONS
- RESPONSE ASSESSMENT
- PLUS IRINOTECAN
- BRAIN-TUMORS
- PHASE-II
- FET PET
- GLIOBLASTOMA