Research ArticleCLINICAL INVESTIGATIONS

The Cost-Effective Use of 18F-FDG PET in the Presurgical Evaluation of Medically Refractory Focal Epilepsy

Terence J. O'Brien, Ken Miles, Robert Ware, Mark J. Cook, David S. Binns and Rodney J. Hicks
Journal of Nuclear Medicine June 2008, 49 (6) 931-937; DOI: https://doi.org/10.2967/jnumed.107.048207

Article Figures & Data

Figures

  • FIGURE 1. 
    FIGURE 1. 

    Plot of cost savings (over medical treatment only) for 3 imaging strategies (VEM/MRI, + SPECT, + PET) with confidence limits determined from sensitivity analysis (dotted lines). Vertical dashed lines indicate reported upper and lower values for cost savings produced by successful epilepsy surgery.

Tables

  • TABLE 1

    Parameters Used in Decision Tree Modeling

    Limit for sensitivity analysis
    ParameterBaseline valueLowerUpper
    Prevalence of class I/II outcomes0.2670.2020.332
    Sensitivity of VEM/MRI for class I/II outcomes1.00.8451.0
    Specificity of VEM/MRI for class I/II outcomes0.7050.5810.804
    Proportion of VEM/MRI indeterminate0.5230.4490.597
    Prevalence of class I/II outcomes if VEM/MRI indeterminate0.2780.1960.378
    Sensitivity of PET for class I/II outcomes if VEM/MRI indeterminate0.960.8050.993
    Specificity of PET for class I/II outcomes if VEM/MRI indeterminate0.2460.1580.363
    Sensitivity of ictal SPECT for class I/II outcomes if VEM/MRI indeterminate0.783*0.664*0.869*
    Specificity of ictal SPECT for class I/II outcomes if VEM/MRI indeterminate0.471*0.262*0.691*
    Cost of VEM$4,110NANA
    Cost of MRI$600NANA
    Cost of ictal SPECT$5,310NANA
    Cost of PET$918NANA
    Cost of surgery$25,691NANA
    Cost savings after class I/II outcome$440,000$0$700,000

    • ↵* Data are based on Won et al. (36).

    • NA = not applied.

  • TABLE 2

    Localizing Rates of Investigations in 176 Patients Who Underwent Presurgical Evaluation for Medically Refractory Focal Epilepsy

    Category18F-FDG PET (n = 176)MRI (n = 176)VEM (n = 172)Intracranial EEG (n = 16)Ictal-interictal SPECT (n = 15)
    Localizing132 (75.0%)63 (35.8%)107 (62.2%)15 (93.8%)9 (60.0%)
    Equivocal12 (6.8%)22 (12.5%)11 (6.4%)—1 (6.7%)
    Nonlocalizing32 (18.2%)91 (51.7%)54 (30.4%)1 (6.3%)5 (33.3%)
  • TABLE 3

    Results of Decision Tree Sensitivity Analysis

    VEM/MRI+SPECT+PET
    ConditionCost of investigations and surgeryPotential class I/II outcomes identifiedCost per class I/II outcomeCost of investigations and surgeryPotential class I/II outcomes identifiedCost per class I/II outcomeICER vs. MRICost of investigations and surgeryPotential class I/II outcomes identifiedCost per class I/II outcomeICER vs. MRI
    Baseline$10,63247.6%$83,715$21,24885.8%$92,785$104,078$21,98297.8%$84,222$84,703
    Minimum prevalence$10,07047.5%$104,899$20,51285.6%$118,564$135,601$21,24198.0%$107,276$109,512
    Maximum prevalence$11,19347.6%$70,844$21,98485.8%$77,137$84,965$22,72497.9%$69,919$69,043
    Minimum PET sensitivity$10,63247.6%$83,715$21,24885.8%$92,785$104,078$21,42689.9%$89,275$95,523
    Maximum PET sensitivity$10,63247.6%$83,715$21,24885.8%$92,785$104,078$22,10099.6%$83,084$82,508
    Minimum PET specificity$10,63247.6%$83,715$21,24885.8%$92,785$104,078$22,84997.8%$87,543$91,171
    Maximum PET specificity$10,63247.6%$83,715$21,24885.8%$92,785$104,078$20,83097.8%$79,807$76,103
    Minimum indeterminate fraction$11,55155.1%$78,575$20,66488.0%$87,934$103,567$21,29598.1%$81,278$84,732
    Maximum indeterminate fraction$9,71340.4%$89,937$21,83183.9%$97,460$104,465$22,66997.8%$86,856$84,681
    Maximum VEM/MRI specificity$9,74347.6%$76,713$20,35985.8%$88,902$104,078$21,09397.8%$88,490$84,703
    Minimum VEM/MRI specificity$11,74647.6%$92,486$22,36285.8%$97,649$104,078$23,09697.8%$88,490$84,703
    Maximum SPECT sensitivity$10,63247.6%$83,715$21,74693.3%$87,335$91,103$21,98297.8%$84,222$84,703
    Minimum SPECT sensitivity$10,63247.6%$83,715$21,01182.4%$95,505$111,604$21,98297.8%$84,222$84,703

    • ICER = incremental cost-effectiveness ratio.

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