title: Cost-effectiveness analysis of amino acid PET-guided surgery for supratentorial high-grade gliomas.
abstract: High-grade gliomas are brain tumors associated with a devastating prognosis. Recent studies have indicated that the combined use of amino acid PET and MRI is superior to MRI alone to plan the surgical resection of high-grade gliomas. The aim of the study was to analyze the cost-effectiveness of the use of amino acid PET for the surgical resection of high-grade gliomas, compared with MRI alone, from the perspective of the national health insurance in Germany.
  
  
  METHODS
  A decision-tree model was set up to compare 2 strategies: the use of MRI alone and the combined use of MRI and PET for surgical resection of high-grade gliomas. For the analysis, 2 scenarios were calculated: a baseline scenario and a more expensive scenario, accounting for disease severity. To test the robustness of the results, probabilistic sensitivity analyses using Monte Carlo simulation were calculated.
  
  
  RESULTS
  Compared with MRI alone, the combined use of MRI and PET showed an incremental cost-effectiveness ratio of €2,948 (€1 ~ U.S.$1.3)per life-year gained for the baseline scenario and an incremental cost-effectiveness ratio of €4,105 per life-year gained for the admissible-charge-rate scenario. In the probabilistic sensitivity analysis in about 60% of the iterations, the combined use of PET and MRI was superior to MRI alone when assuming a willingness-to-pay threshold of €30,000.
  
  
  CONCLUSIONS
  The model indicates that the combined use of MRI and PET may be cost-effective. The results of this analysis have to be considered carefully because there was only limited empiric evidence for several input parameters.
authors.affiliation: Department of Nuclear Medicine of the Heinrich-Heine University of Duesseldorf at the Research Centre Juelich, Juelich, Germany. a.heinzel@fz-juelich.de
authors.forename: Alexander
authors.initials: A
authors.lastname: Heinzel
authors.forename: Stephanie
authors.initials: S
authors.lastname: Stock
authors.forename: Karl-Josef
authors.initials: KJ
authors.lastname: Langen
authors.forename: Dirk
authors.initials: D
authors.lastname: Müller
mesh_terms: D000596:Amino Acids; D001932:Brain Neoplasms / Q000000981:diagnostic imaging* / Q000473:pathology / Q000601:surgery*; D003362:Cost-Benefit Analysis; D005910:Glioma / Q000000981:diagnostic imaging* / Q000473:pathology / Q000601:surgery*; D006801:Humans; D008279:Magnetic Resonance Imaging; D009010:Monte Carlo Method; D060787:Neoplasm Grading; D049268:Positron-Emission Tomography / Q000191:economics*; D011336:Probability; D025321:Surgery, Computer-Assisted / Q000191:economics*
chemical_list: D000596:Amino Acids