PT  - JOURNAL ARTICLE
AU  - Jurij Rosen
AU  - Garry Ceccon
AU  - Elena Katharina Bauer
AU  - Jan Michael Werner
AU  - Caroline Tscherpel
AU  - Veronika Dunkl
AU  - Marion Rapp
AU  - Michael Sabel
AU  - Ulrich Herrlinger
AU  - Alexander Heinzel
AU  - Niklas Schaefer
AU  - Maximilian Ruge
AU  - Roland Goldbrunner
AU  - Gabriele Stoffels
AU  - Christoph Kabbasch
AU  - Gereon Rudolf Fink
AU  - Karl-Josef Langen
AU  - Norbert Galldiks
TI  - Cost-effectiveness of <sup>18</sup>F-FET PET for early treatment response assessment in glioma patients following adjuvant temozolomide chemotherapy
AID  - 10.2967/jnumed.122.263790
DP  - 2022 Apr 01
TA  - Journal of Nuclear Medicine
PG  - jnumed.122.263790
4099  - http://jnm.snmjournals.org/content/early/2022/04/14/jnumed.122.263790.short
4100  - http://jnm.snmjournals.org/content/early/2022/04/14/jnumed.122.263790.full
AB  - Rationale: In light of increasing healthcare costs, higher medical expenses should be justified socio-economically. Therefore, we calculated the effectiveness and cost-effectiveness of positron emission tomography (PET) using the radiolabeled amino acid O-(2-[18F]-fluoroethyl)-L-tyrosine (18F-FET) compared to conventional magnetic resonance imaging (MRI) for early identification of responders to adjuvant temozolomide chemotherapy. A recently published study in isocitrate dehydrogenase-wildtype glioma patients suggested that 18F-FET PET parameter changes predicted a significantly longer survival already after two cycles while MRI changes were not significant. Methods: To determine the effectiveness and cost-effectiveness of serial 18F-FET PET imaging, we analyzed published clinical data and calculated the associated costs from the perspective of the German Statutory Health Insurance system. Based on a decision-tree model, the effectiveness of 18F-FET PET and MRI was calculated, i.e., the probability to correctly identify a responder as defined by an overall survival ≥15 months. To determine the cost-effectiveness, the incremental cost-effectiveness ratio (ICER) was calculated, i.e., the cost for each additionally identified responder by 18F-FET PET who would have remained undetected by MRI. The robustness of the results was tested by deterministic and probabilistic Monte Carlo sensitivity analyses. Results: Compared to MRI, 18F-FET PET increased the rate of correctly identified responders to chemotherapy by 26%; thus, four patients needed to be examined by 18F-FET PET to identify one additional responder. Considering the respective cost for serial 18F-FET PET and MRI, the ICER resulted in €4,396.83 for each additional correctly identified responder by 18F-FET PET. Sensitivity analyses confirmed the robustness of the results. Conclusion: In contrast to conventional MRI, the model suggests that 18F-FET PET is cost-effective in terms of ICER values. Considering the high cost of temozolomide, the integration of 18F-FET PET has the potential to avoid premature chemotherapy discontinuation at reasonable cost.