Skip to main content
Erschienen in: European Journal of Nuclear Medicine and Molecular Imaging 7/2012

01.07.2012 | Original Article

Cost-effectiveness analysis of FET PET-guided target selection for the diagnosis of gliomas

verfasst von: Alexander Heinzel, Stephanie Stock, Karl-Josef Langen, Dirk Müller

Erschienen in: European Journal of Nuclear Medicine and Molecular Imaging | Ausgabe 7/2012

Einloggen, um Zugang zu erhalten

Abstract

Purpose

Several diagnostic trials have indicated that the combined use of 18F-fluoroethyl-l-tyrosine (FET) PET and MRI may be superior to MRI alone in selecting the biopsy site for the diagnosis of gliomas. We estimated the cost-effectiveness of the use of amino acid PET compared to MRI alone from the perspective of the German statutory health insurance.

Methods

To evaluate the incremental cost-effectiveness of the use of amino acid PET, a decision tree model was built. The effectiveness of FET PET was determined by the probability of a correct diagnosis. Costs were estimated for a baseline scenario and for a more expensive scenario in which disease severity was considered. The robustness of the results was tested using deterministic and probabilistic sensitivity analyses.

Results

The combined use of PET and MRI resulted in an increase of 18.5% in the likelihood of a correct diagnosis. The incremental cost-effectiveness ratio for one additional correct diagnosis using FET PET was €6,405 for the baseline scenario and €9,114 for the scenario based on higher disease severity. The probabilistic sensitivity analysis confirmed the robustness of the results.

Conclusion

The model indicates that the use of amino acid PET may be cost-effective in patients with glioma. As a result of several limitations in the data used for the model, further studies are needed to confirm the results.
Literatur
1.
Zurück zum Zitat Floeth FW, Pauleit D, Sabel M, Stoffels G, Reifenberger G, Riemenschneider MJ, et al. Prognostic value of O-(2-18F-fluoroethyl)-L-tyrosine PET and MRI in low-grade glioma. J Nucl Med. 2007;48(4):519–27.PubMedCrossRef Floeth FW, Pauleit D, Sabel M, Stoffels G, Reifenberger G, Riemenschneider MJ, et al. Prognostic value of O-(2-18F-fluoroethyl)-L-tyrosine PET and MRI in low-grade glioma. J Nucl Med. 2007;48(4):519–27.PubMedCrossRef
2.
Zurück zum Zitat Deb P, Sharma MC, Mahapatra AK, Agarwal D, Sarkar C. Glioblastoma multiforme with long term survival. Neurol India. 2005;53(3):329–32.PubMedCrossRef Deb P, Sharma MC, Mahapatra AK, Agarwal D, Sarkar C. Glioblastoma multiforme with long term survival. Neurol India. 2005;53(3):329–32.PubMedCrossRef
3.
Zurück zum Zitat Walid MS, Smisson III HF, Robinson Jr JS. Long-term survival after glioblastoma multiforme. South Med J. 2008;101(9):971–2.PubMedCrossRef Walid MS, Smisson III HF, Robinson Jr JS. Long-term survival after glioblastoma multiforme. South Med J. 2008;101(9):971–2.PubMedCrossRef
4.
Zurück zum Zitat Scoccianti S, Magrini SM, Ricardi U, Detti B, Buglione M, Sotti G, et al. Patterns of care and survival in a retrospective analysis of 1059 patients with glioblastoma multiforme treated between 2002 and 2007: a multicenter study by the Central Nervous System Study Group of Airo (Italian Association of Radiation Oncology). Neurosurgery. 2010;67(2):446–58.PubMedCrossRef Scoccianti S, Magrini SM, Ricardi U, Detti B, Buglione M, Sotti G, et al. Patterns of care and survival in a retrospective analysis of 1059 patients with glioblastoma multiforme treated between 2002 and 2007: a multicenter study by the Central Nervous System Study Group of Airo (Italian Association of Radiation Oncology). Neurosurgery. 2010;67(2):446–58.PubMedCrossRef
5.
Zurück zum Zitat Grant R. Overview: brain tumour diagnosis and management/Royal College of Physicians guidelines. J Neurol Neurosurg Psychiatry. 2004;75 Suppl 2:ii18–23.PubMedCrossRef Grant R. Overview: brain tumour diagnosis and management/Royal College of Physicians guidelines. J Neurol Neurosurg Psychiatry. 2004;75 Suppl 2:ii18–23.PubMedCrossRef
6.
Zurück zum Zitat Schneider T, Mawrin C, Scherlach C, Skalej M, Firsching R. Gliomas in adults. Dtsch Arztebl Int. 2010;107(45):799–808.PubMed Schneider T, Mawrin C, Scherlach C, Skalej M, Firsching R. Gliomas in adults. Dtsch Arztebl Int. 2010;107(45):799–808.PubMed
7.
Zurück zum Zitat Stupp R, Roila F. Malignant glioma: ESMO clinical recommendations for diagnosis, treatment and follow-up. Ann Oncol. 2008;19 Suppl 2:ii83–5.PubMedCrossRef Stupp R, Roila F. Malignant glioma: ESMO clinical recommendations for diagnosis, treatment and follow-up. Ann Oncol. 2008;19 Suppl 2:ii83–5.PubMedCrossRef
8.
Zurück zum Zitat Kaufman HH, Catalano Jr LW. Diagnostic brain biopsy: a series of 50 cases and a review. Neurosurgery. 1979;4(2):129–36.PubMedCrossRef Kaufman HH, Catalano Jr LW. Diagnostic brain biopsy: a series of 50 cases and a review. Neurosurgery. 1979;4(2):129–36.PubMedCrossRef
9.
Zurück zum Zitat Sawyer J, Ellner J, Ransohoff DF. To biopsy or not to biopsy in suspected herpes simplex encephalitis: a quantitative analysis. Med Decis Mak. 1988;8(2):95–101.CrossRef Sawyer J, Ellner J, Ransohoff DF. To biopsy or not to biopsy in suspected herpes simplex encephalitis: a quantitative analysis. Med Decis Mak. 1988;8(2):95–101.CrossRef
11.
12.
Zurück zum Zitat Langen KJ, Hamacher K, Weckesser M, Floeth F, Stoffels G, Bauer D, et al. O-(2-[18F]fluoroethyl)-L-tyrosine: uptake mechanisms and clinical applications. Nucl Med Biol. 2006;33(3):287–94.PubMedCrossRef Langen KJ, Hamacher K, Weckesser M, Floeth F, Stoffels G, Bauer D, et al. O-(2-[18F]fluoroethyl)-L-tyrosine: uptake mechanisms and clinical applications. Nucl Med Biol. 2006;33(3):287–94.PubMedCrossRef
13.
Zurück zum Zitat Pirotte B, Goldman S, Massager N, David P, Wikler D, Vandesteene A, et al. Comparison of 18F-FDG and 11C-methionine for PET-guided stereotactic brain biopsy of gliomas. J Nucl Med. 2004;45(8):1293–8.PubMed Pirotte B, Goldman S, Massager N, David P, Wikler D, Vandesteene A, et al. Comparison of 18F-FDG and 11C-methionine for PET-guided stereotactic brain biopsy of gliomas. J Nucl Med. 2004;45(8):1293–8.PubMed
14.
Zurück zum Zitat Langen KJ, Floeth FW, Stoffels G, Hamacher K, Coenen HH, Pauleit D. Improved diagnostics of cerebral gliomas using FET PET. Z Med Phys. 2007;17(4):237–41.PubMedCrossRef Langen KJ, Floeth FW, Stoffels G, Hamacher K, Coenen HH, Pauleit D. Improved diagnostics of cerebral gliomas using FET PET. Z Med Phys. 2007;17(4):237–41.PubMedCrossRef
15.
Zurück zum Zitat Goldman S, Levivier M, Pirotte B, Brucher JM, Wikler D, Damhaut P, et al. Regional methionine and glucose uptake in high-grade gliomas: a comparative study on PET-guided stereotactic biopsy. J Nucl Med. 1997;38(9):1459–62.PubMed Goldman S, Levivier M, Pirotte B, Brucher JM, Wikler D, Damhaut P, et al. Regional methionine and glucose uptake in high-grade gliomas: a comparative study on PET-guided stereotactic biopsy. J Nucl Med. 1997;38(9):1459–62.PubMed
16.
Zurück zum Zitat Kracht LW, Miletic H, Busch S, Jacobs AH, Voges J, Hoevels M, et al. Delineation of brain tumor extent with [11C]L-methionine positron emission tomography: local comparison with stereotactic histopathology. Clin Cancer Res. 2004;10(21):7163–70.PubMedCrossRef Kracht LW, Miletic H, Busch S, Jacobs AH, Voges J, Hoevels M, et al. Delineation of brain tumor extent with [11C]L-methionine positron emission tomography: local comparison with stereotactic histopathology. Clin Cancer Res. 2004;10(21):7163–70.PubMedCrossRef
17.
Zurück zum Zitat Miwa K, Shinoda J, Yano H, Okumura A, Iwama T, Nakashima T, et al. Discrepancy between lesion distributions on methionine PET and MR images in patients with glioblastoma multiforme: insight from a PET and MR fusion image study. J Neurol Neurosurg Psychiatry. 2004;75(10):1457–62.PubMedCrossRef Miwa K, Shinoda J, Yano H, Okumura A, Iwama T, Nakashima T, et al. Discrepancy between lesion distributions on methionine PET and MR images in patients with glioblastoma multiforme: insight from a PET and MR fusion image study. J Neurol Neurosurg Psychiatry. 2004;75(10):1457–62.PubMedCrossRef
18.
Zurück zum Zitat Muragaki Y, Chernov M, Maruyama T, Ochiai T, Taira T, Kubo O, et al. Low-grade glioma on stereotactic biopsy: how often is the diagnosis accurate? Minim Invasive Neurosurg. 2008;51(5):275–9.PubMedCrossRef Muragaki Y, Chernov M, Maruyama T, Ochiai T, Taira T, Kubo O, et al. Low-grade glioma on stereotactic biopsy: how often is the diagnosis accurate? Minim Invasive Neurosurg. 2008;51(5):275–9.PubMedCrossRef
19.
Zurück zum Zitat Pauleit D, Floeth F, Hamacher K, Riemenschneider MJ, Reifenberger G, Müller HW, et al. O-(2-[18F]fluoroethyl)-L-tyrosine PET combined with MRI improves the diagnostic assessment of cerebral gliomas. Brain. 2005;128(Pt 3):678–87.PubMedCrossRef Pauleit D, Floeth F, Hamacher K, Riemenschneider MJ, Reifenberger G, Müller HW, et al. O-(2-[18F]fluoroethyl)-L-tyrosine PET combined with MRI improves the diagnostic assessment of cerebral gliomas. Brain. 2005;128(Pt 3):678–87.PubMedCrossRef
20.
Zurück zum Zitat Pirotte B, Goldman S, Bidaut LM, Luxen A, Stanus E, Brucher JM, et al. Use of positron emission tomography (PET) in stereotactic conditions for brain biopsy. Acta Neurochir (Wien). 1995;134(1–2):79–82.CrossRef Pirotte B, Goldman S, Bidaut LM, Luxen A, Stanus E, Brucher JM, et al. Use of positron emission tomography (PET) in stereotactic conditions for brain biopsy. Acta Neurochir (Wien). 1995;134(1–2):79–82.CrossRef
21.
Zurück zum Zitat Langen KJ, Bartenstein P, Boecker H, Brust P, Coenen HH, Drzezga A, et al. German guidelines for brain tumour imaging by PET and SPECT using labelled amino acids. Nuklearmedizin. 2011;50(4):167–73.PubMedCrossRef Langen KJ, Bartenstein P, Boecker H, Brust P, Coenen HH, Drzezga A, et al. German guidelines for brain tumour imaging by PET and SPECT using labelled amino acids. Nuklearmedizin. 2011;50(4):167–73.PubMedCrossRef
22.
Zurück zum Zitat Vander BT, Asenbaum S, Bartenstein P, Halldin C, Kapucu O, Van Laere K, et al. EANM procedure guidelines for brain tumour imaging using labelled amino acid analogues. Eur J Nucl Med Mol Imaging. 2006;33(11):1374–80.CrossRef Vander BT, Asenbaum S, Bartenstein P, Halldin C, Kapucu O, Van Laere K, et al. EANM procedure guidelines for brain tumour imaging using labelled amino acid analogues. Eur J Nucl Med Mol Imaging. 2006;33(11):1374–80.CrossRef
23.
Zurück zum Zitat Heinzel A, Stock S, Langen KJ, Müller D. Cost-effectiveness analysis of amino acid PET guided surgery for supratentorial high-grade gliomas. J Nucl Med. 2011; in Press. Heinzel A, Stock S, Langen KJ, Müller D. Cost-effectiveness analysis of amino acid PET guided surgery for supratentorial high-grade gliomas. J Nucl Med. 2011; in Press.
24.
Zurück zum Zitat Doubilet P, Begg CB, Weinstein MC, Braun P, McNeil BJ. Probabilistic sensitivity analysis using Monte Carlo simulation. A practical approach. Med Decis Mak. 1985;5(2):157–77.CrossRef Doubilet P, Begg CB, Weinstein MC, Braun P, McNeil BJ. Probabilistic sensitivity analysis using Monte Carlo simulation. A practical approach. Med Decis Mak. 1985;5(2):157–77.CrossRef
25.
Zurück zum Zitat Meltzer MI, Dennis DT, Orloski KA. The cost effectiveness of vaccinating against Lyme disease. Emerg Infect Dis. 1999;5(3):321–8.PubMedCrossRef Meltzer MI, Dennis DT, Orloski KA. The cost effectiveness of vaccinating against Lyme disease. Emerg Infect Dis. 1999;5(3):321–8.PubMedCrossRef
26.
Zurück zum Zitat Burgos JL, Gaebler JA, Strathdee SA, Lozada R, Staines H, Patterson TL. Cost-effectiveness of an intervention to reduce HIV/STI incidence and promote condom use among female sex workers in the Mexico-US border region. PLoS One. 2010;5(6):e11413.PubMedCrossRef Burgos JL, Gaebler JA, Strathdee SA, Lozada R, Staines H, Patterson TL. Cost-effectiveness of an intervention to reduce HIV/STI incidence and promote condom use among female sex workers in the Mexico-US border region. PLoS One. 2010;5(6):e11413.PubMedCrossRef
27.
Zurück zum Zitat Stupp R, Mason WP, van den Bent MJ, Weller M, Fisher B, Taphoorn MJ, et al. Radiotherapy plus concomitant and adjuvant temozolomide for glioblastoma. N Engl J Med. 2005;352(10):987–96.PubMedCrossRef Stupp R, Mason WP, van den Bent MJ, Weller M, Fisher B, Taphoorn MJ, et al. Radiotherapy plus concomitant and adjuvant temozolomide for glioblastoma. N Engl J Med. 2005;352(10):987–96.PubMedCrossRef
28.
Zurück zum Zitat Uyl-de Groot CA, Stupp R, van der Bent M. Cost-effectiveness of temozolomide for the treatment of newly diagnosed glioblastoma multiforme. Expert Rev Pharmacoecon Outcomes Res. 2009;9(3):235–41.PubMedCrossRef Uyl-de Groot CA, Stupp R, van der Bent M. Cost-effectiveness of temozolomide for the treatment of newly diagnosed glioblastoma multiforme. Expert Rev Pharmacoecon Outcomes Res. 2009;9(3):235–41.PubMedCrossRef
29.
Zurück zum Zitat Plotkin M, Blechschmidt C, Auf G, Nyuyki F, Geworski L, Denecke T, et al. Comparison of F-18 FET-PET with F-18 FDG-PET for biopsy planning of non-contrast-enhancing gliomas. Eur Radiol. 2010;20(10):2496–502.PubMedCrossRef Plotkin M, Blechschmidt C, Auf G, Nyuyki F, Geworski L, Denecke T, et al. Comparison of F-18 FET-PET with F-18 FDG-PET for biopsy planning of non-contrast-enhancing gliomas. Eur Radiol. 2010;20(10):2496–502.PubMedCrossRef
30.
Zurück zum Zitat Ginsberg LE, Fuller GN, Hashmi M, Leeds NE, Schomer DF. The significance of lack of MR contrast enhancement of supratentorial brain tumors in adults: histopathological evaluation of a series. Surg Neurol. 1998;49(4):436–40.PubMedCrossRef Ginsberg LE, Fuller GN, Hashmi M, Leeds NE, Schomer DF. The significance of lack of MR contrast enhancement of supratentorial brain tumors in adults: histopathological evaluation of a series. Surg Neurol. 1998;49(4):436–40.PubMedCrossRef
31.
Zurück zum Zitat Temple R, Ellenberg SS. Placebo-controlled trials and active-control trials in the evaluation of new treatments. Part 1: ethical and scientific issues. Ann Intern Med. 2000;133(6):455–63.PubMed Temple R, Ellenberg SS. Placebo-controlled trials and active-control trials in the evaluation of new treatments. Part 1: ethical and scientific issues. Ann Intern Med. 2000;133(6):455–63.PubMed
32.
Zurück zum Zitat Miller FG, Brody H. What makes placebo-controlled trials unethical? Am J Bioeth. 2002;2(2):3–9.PubMedCrossRef Miller FG, Brody H. What makes placebo-controlled trials unethical? Am J Bioeth. 2002;2(2):3–9.PubMedCrossRef
Metadaten
Titel
Cost-effectiveness analysis of FET PET-guided target selection for the diagnosis of gliomas
verfasst von
Alexander Heinzel
Stephanie Stock
Karl-Josef Langen
Dirk Müller
Publikationsdatum
01.07.2012
Verlag
Springer-Verlag
Erschienen in
European Journal of Nuclear Medicine and Molecular Imaging / Ausgabe 7/2012
Print ISSN: 1619-7070
Elektronische ISSN: 1619-7089
DOI
https://doi.org/10.1007/s00259-012-2093-0

Weitere Artikel der Ausgabe 7/2012

European Journal of Nuclear Medicine and Molecular Imaging 7/2012 Zur Ausgabe