Molecular imaging with positron emission tomography and computed tomography (PET/CT) for selecting first-line targeted treatment in metastatic breast cancer: a cost-effectiveness study.

Rositsa G Koleva-Kolarova,Erik Buskens,Marcel J.W Greuter,Erik F.J De Vries,Karin M Vermeulen,David Parkin,Talitha L Feenstra,Geertruida H De Bock

doi:10.18632/oncotarget.24869

Abstract

Our aim was to evaluate the potential cost-effectiveness of PET/CT with FES and 89Zr-trastuzumab compared to pathology to select first-line targeted treatment in metastatic breast cancer (MBC) patients with non-rapidly progressive disease. A previously published and validated model was extended and adapted for this analysis. Two alternative scenarios were compared. In the care as usual pathway first-line targeted treatment of MBC patients was assigned on the basis of pathology results, while in the intervention pathway treatment selection was based on the results from the PET/CT imaging. Costs, life years gained (LYG) and incremental cost-effectiveness ratios (ICER) were calculated. More MBC lesions were detected in the intervention pathway than in the care as usual pathway. The diagnostic costs to evaluate the receptor status and the treatment costs were higher in the intervention strategy, as were total costs and total LYG. The ICER for replacing biopsies with PET/CT imaging with FES and 89Zr-trastuzumab, assuming sensitivity of 77.1% and specificity of 80%, ranged from €71,000 to €77,000 per LYG. When assuming sensitivity of 80% and specificity of 76.7%, the ICER for replacing biopsies with PET/CT imaging with FES and 89Zr-trastuzumab ranged from to €74,000 to €80,000 per LYG. The application of PET/CT with FES and 89Zr-trastuzumab in first-line treatment selection for MBC patients has the potential to be a cost-effective intervention. Our analysis demonstrated that even a small increase in the sensitivity and the specificity of PET/CT can have a large impact on its potential cost-effectiveness.

Highlights

Breast cancer can present in many different ways with regards to stage, phenotype, location, and heterogeneity of the disease
For baseline scenario 1 we assumed that the sensitivity of FES-PET/CT and 89Zr-trastuzumab PET/CT was set at 77.1% and the specificity was set at 80%, as this was the minimum at which PET/CT could demonstrate potential cost-effectiveness
For baseline scenario 2 we assumed that the sensitivity of FES-PET/CT and 89Zrtrastuzumab PET/CT was set at 80% and the specificity was set at 76.7%, as this was the minimum at which positron emission tomography and computed tomography (PET/ CT) could demonstrate potential cost-effectiveness

Summary

Introduction

Breast cancer can present in many different ways with regards to stage, phenotype, location, and heterogeneity of the disease. Treatment of non-rapidly progressive metastatic breast cancer (MBC) is stratified on the basis of the tumor expression of receptors that are targets for pharmacological intervention. Patients with negative receptor status (HER2- and HR-negative) of the metastatic disease do not respond to targeted therapy in general, chemotherapy remains as a treatment option [3, 4]. New targeted therapies regularly become available (e.g. palbociclib, pertuzumab) and a prior selection of patients is crucial to optimize outcomes of targeted therapy at acceptable costs. This may improve progression-free and overall survival [5], and further minimize adverse effects and avoid unnecessary harms and associated costs for those who do not respond

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Conclusion