Abstract
Neuroendocrine tumors (NETs) are relatively rare neoplasms arising from the hormone-producing neuroendocrine system that can occur in various organs such as pancreas, small bowel, stomach and lung. As the majority of these tumors express somatostatin receptors (SSR) on their cell membrane, utilization of SSR analogs in nuclear medicine is a promising, but relatively costly approach for detection and localization. The aim of this study was to analyze the cost-effectiveness of 68Ga-DOTA-TATE PET/CT (Gallium-68 DOTA-TATE Positron emission tomography/computed tomography) compared to 111In-pentetreotide SPECT/CT (Indium-111 pentetreotide Single Photon emission computed tomography/computed tomography) and to CT (computed tomography) alone in detection of NETs. A decision model on the basis of Markov simulations evaluated lifetime costs and quality-adjusted life years (QALYs) related to either a CT, SPECT/CT or PET/CT. Model input parameters were obtained from publicized research projects. The analysis is grounded on the US healthcare system. Deterministic sensitivity analysis of diagnostic parameters and probabilistic sensitivity analysis predicated on a Monte Carlo simulation with 30,000 reiterations was executed. The willingness-to-pay (WTP) was determined to be $ 100,000/QALY. In the base-case investigation, PET/CT ended up with total costs of $88,003.07 with an efficacy of 4.179, whereas CT ended up with total costs of $88,894.71 with an efficacy of 4.165. SPECT/CT ended up with total costs of $89,973.34 with an efficacy of 4.158. Therefore, the strategies CT and SPECT/CT were dominated by PET/CT in the base-case scenario. In the sensitivity analyses, PET/CT remained a cost-effective strategy. This result was due to reduced therapy costs of timely detection. The additional costs of 68Ga-DOTA-TATE PET/CT when compared to CT alone are justified in the light of potential savings in therapy costs and better outcomes.
Highlights
Neuroendocrine tumors (NETs) are rare malignancies arising from the hormoneproducing neuroendocrine system [1]
In view of the growing clinical importance of neuroendocrine neoplasms with an increasing incidence on the one hand and increasingly sophisticated but expensive imaging procedures on the other, the aim of this study was to analyze the cost-effectiveness of CT, 111 In-pentetreotide SPECT/CT and 68 Ga-DOTA-TATE PET/CT for detecting neuroendocrine tumors based on the US healthcare system
Taking into account the results from the Markov model, a baseline cost-effectiveness analysis for CT led to summed up costs of $88,894.71 and an efficacy of 4.165 quality-adjusted life years (QALYs)
Summary
Neuroendocrine tumors (NETs) are rare malignancies arising from the hormoneproducing neuroendocrine system [1]. Since 1999, SPECT/CT has been used in clinical routine starting with a dual-headed sodium iodide crystal gamma camera combined with a low-dose CT and has developed since [14] This imaging method offers many advantages in diagnostics as the radioactive tracers that are used to detect malignancies in the body have a relatively long half-life compared to tracers used in PET/CT [15]. In view of the growing clinical importance of neuroendocrine neoplasms with an increasing incidence on the one hand and increasingly sophisticated but expensive imaging procedures on the other, the aim of this study was to analyze the cost-effectiveness of CT, 111 In-pentetreotide SPECT/CT and 68 Ga-DOTA-TATE PET/CT for detecting neuroendocrine tumors based on the US healthcare system
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