RT Journal Article SR Electronic T1 Cost-effectiveness of 18F-FET PET for early treatment response assessment in glioma patients following adjuvant temozolomide chemotherapy JF Journal of Nuclear Medicine JO J Nucl Med FD Society of Nuclear Medicine SP jnumed.122.263790 DO 10.2967/jnumed.122.263790 A1 Jurij Rosen A1 Garry Ceccon A1 Elena Katharina Bauer A1 Jan Michael Werner A1 Caroline Tscherpel A1 Veronika Dunkl A1 Marion Rapp A1 Michael Sabel A1 Ulrich Herrlinger A1 Alexander Heinzel A1 Niklas Schaefer A1 Maximilian Ruge A1 Roland Goldbrunner A1 Gabriele Stoffels A1 Christoph Kabbasch A1 Gereon Rudolf Fink A1 Karl-Josef Langen A1 Norbert Galldiks YR 2022 UL http://jnm.snmjournals.org/content/early/2022/04/14/jnumed.122.263790.abstract 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.