Follow-Up 18F-FDG PET/CT versus Contrast-Enhanced CT after Ablation of Liver Metastases of Colorectal Carcinoma-A Cost-Effectiveness Analysis.

Moritz L Schnitzer,Vincent Schwarze,Johannes Rübenthaler,Dominik Nörenberg,Matthias F Froelich,Thomas Huber,Andrei Todica,Eva Gresser,Felix G Gassert

doi:10.3390/cancers12092432

Abstract

Purpose: After a percutaneous ablation of colorectal liver metastases (CRLM), follow-up investigations to evaluate potential tumor recurrence are necessary. The aim of this study was to analyze whether a combined 18F-Fluordesoxyglucose positron emission tomography-computed tomography (18F-FDG PET/CT) scan is cost-effective compared to a contrast-enhanced computed tomography (CE-CT) scan for detecting local tumor progression. Materials and Methods: A decision model based on Markov simulations that estimated lifetime costs and quality-adjusted life years (QALYs) was developed. Model input parameters were obtained from the recent literature. Deterministic sensitivity analysis of diagnostic parameters based on a Monte-Carlo simulation with 30,000 iterations was performed. The willingness-to-pay (WTP) was set to $100,000/QALY. Results: In the base-case scenario, CE-CT resulted in total costs of $28,625.08 and an efficacy of 0.755 QALYs, whereas 18F-FDG PET/CT resulted in total costs of $29,239.97 with an efficacy of 0.767. Therefore, the corresponding incremental cost-effectiveness ratio (ICER) of 18F-FDG PET/CT was $50,338.96 per QALY indicating cost-effectiveness based on the WTP threshold set above. The results were stable in deterministic and probabilistic sensitivity analyses. Conclusion: Based on our model, 18F-FDG PET/CT can be considered as a cost-effective imaging alternative for follow-up investigations after percutaneous ablation of colorectal liver metastases.

Highlights

Colorectal cancer (CRC) is among the most prevalent tumor malignancies worldwide
$50,338.96 per quality-adjusted life years (QALYs) indicating cost-effectiveness based on the WTP threshold set above
Based on our model, 18F-FDG PET/CT can be considered as a cost-effective imaging alternative for follow-up investigations after percutaneous ablation of colorectal liver metastases

Summary

Introduction

Colorectal cancer (CRC) is among the most prevalent tumor malignancies worldwide. Every tenth diagnosed cancer is attributable to a colorectal tumor. Cancers 2020, 12, 2432 with CRC will be diagnosed with metastases either at the time of diagnosis or as part of recurrent disease where the liver is the most common site for metastases [2]. The liver is the most common site of hematogenous metastatic spread in patients with CRC with 50–60% of patients with CRC developing liver metastases [3]. Surgical resection has emerged as the treatment of choice for solitary liver metastases given that these patients achieve 5-year survival rates above 50% [2]. Only 25% of affected patients are suitable to undergo a surgical procedure due to size, number and localization of metastases [2]. For the remaining majority of patients who are not suitable for surgery, several alternative, minimally invasive treatment options such as percutaneous ablation, for example radiofrequency ablation (RFA) or microwave ablation (MWA), are already applied in clinical routine and have been shown to be efficient alternatives in treatment of these patients [4,5]

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