Abstract
Background and Purpose: Glioblastomas are the most aggressive of all gliomas. The prognosis of these gliomas, which are classified as grade IV tumors by the World Health Organization (WHO), is poor. Combination therapy, including surgery, radiotherapy, and chemotherapy has variable outcomes and is expensive. In light of rising healthcare costs, there are societal demands for the justification of medical expenses. Therefore, we calculated the cost-effectiveness of follow-up [18F] fluoroethyl-L-tyrosine ([18F] FET) positron emission tomography (PET) scans performed on patients with glioblastoma after surgery and before commencing temozolomide maintenance treatment.Materials and Methods: To determine the cost-effectiveness of follow-up [18F] FET PET procedures, we examined published clinical data and calculated the associated costs in the context of Belgian healthcare. We subsequently performed one-way deterministic sensitivity analysis and Monte Carlo analysis on the calculated ratios.Results: The decision tree based on overall survival rates showed that the number of non-responders identified using PET was 57.14% higher than the number of non-responders identified using conventional MRI. Further, the decision tree based on progression-free survival rates revealed a comparable increase of 57.50% non-responders identified. The calculated cost of two required PET scans per patient during the follow-up treatment phase was 780.50 euros. Two cost-effectiveness ratios were determined for overall survival and progression-free survival rates. Both of these calculations yielded very similar results: incremental cost-effectiveness ratios of 1,365.86 and 1,357.38 euros, respectively, for each identified non-responder. The findings of the sensitivity analysis supported the calculated results, confirming that the obtained data were robust.Conclusion: Our comparative study of conventional MRI and [18F] FET PET revealed that the latter is a valuable tool for predicting the treatment responses of patients with glioblastomas to follow-up temozolomide maintenance treatment while considering its cost-effectiveness. Thus, [18F] FET PET scans enable clinical outcomes to be predicted accurately and at a low cost. Moreover, given the robustness of the data in the sensitivity analyses, the level of certainty of this outcome is acceptable.
Highlights
Glioblastomas account for 54% of all gliomas in adults and are considered the most aggressive tumors within this category [1]
The state-of-the-art treatment consists of surgery followed by adjuvant combination therapy that entails radiochemotherapy and six cycles of maintenance chemotherapy using temozolomide (TMZ) [2, 3]
Drawings of three-dimensional contrastenhancing volumes were used to delineate the tumors on the magnetic resonance imaging (MRI) images, whereas a 1.6 cut-off tumor-to-background (TBR) value was used to delineate tumor tissue in the [18F] [18F] Fluoroethyl-L-tyrosine (FET) images based on previous findings on the best cut-off value for distinguishing tumor tissue from non-tumor tissue [13]
Summary
Glioblastomas account for 54% of all gliomas in adults and are considered the most aggressive tumors within this category [1]. During the follow-up phase, it is difficult to discriminate between pseudo-progression after the completion of treatment vs tumor progression using conventional MRI. This is because contrast enhancement with MRI is an aspecific finding that merely indicates leakage of the contrast medium through the bloodbrain-barrier, which may be treatment related [8, 9]. Glioblastomas are the most aggressive of all gliomas The prognosis of these gliomas, which are classified as grade IV tumors by the World Health Organization (WHO), is poor. We calculated the cost-effectiveness of follow-up [18F] fluoroethyl-L-tyrosine ([18F] FET) positron emission tomography (PET) scans performed on patients with glioblastoma after surgery and before commencing temozolomide maintenance treatment
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