The use of O-(2-18F-fluoroethyl)-L-tyrosine PET for treatment management of bevacizumab and irinotecan in patients with recurrent high-grade glioma: a cost-effectiveness analysis

A. Heinzel, D. Muller, K.J. Langen, M. Blaum, F.A. Verburg, F.M. Mottaghy, N. Galldiks

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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 languageEnglish
Pages (from-to)1217-1222
Number of pages6
JournalJournal of Nuclear Medicine
Volume54
Issue number8
DOIs
Publication statusPublished - 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

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