title: The use of O-(2-18F-fluoroethyl)-L-tyrosine PET for treatment management of bevacizumab and irinotecan in patients with recurrent high-grade glioma: a cost-effectiveness analysis.
abstract: To date, the use of structural MR imaging (including contrast-enhanced and T2-weighted or fluid-attenuated inversion recovery-weighted images) is the standard method to diagnose tumor progression and to assess antiangiogenic treatment effects. However, several studies have suggested that O-(2-(18)F-fluoroethyl)-L-tyrosine ((18)F-FET) PET adds valuable clinical information to the information derived from structural MR imaging alone. We evaluated the effectiveness and cost-effectiveness of the addition of (18)F-FET PET to structural MR imaging for the management of treatment with bevacizumab and irinotecan (BEV/IR) in patients with recurrent high-grade glioma compared with MR imaging alone from the perspective of the German Statutory Health Insurance.
  
  
  METHODS
  To evaluate the incremental cost-effectiveness of the additional use of (18)F-FET PET, a decision tree model was used. Effectiveness of (18)F-FET PET was defined as correct identification of both tumor progression before BEV/IR treatment initiation and BEV/IR treatment response and was evaluated for the combination of (18)F-FET PET and MR imaging compared with MR imaging alone. Costs were estimated for a baseline scenario and for a more expensive scenario. The robustness of the results was tested using deterministic and probabilistic sensitivity analyses.
  
  
  RESULTS
  The use of (18)F-FET PET resulted in a number needed to diagnose of 2.4, that is, 3 additional patients have to be diagnosed to avoid 1 wrong diagnosis. The incremental cost-effectiveness ratio of (18)F-FET PET/MR imaging compared with MR imaging alone was €5,725 (€1 ≈ $1.30) for the baseline scenario and €8,145 for the more expensive scenario per additional correct diagnosis. The probabilistic sensitivity analysis confirmed the robustness of the results.
  
  
  CONCLUSIONS
  The model suggests that the additional use of (18)F-FET PET in the management of patients with recurrent high-grade glioma treated with BEV/IR may be cost-effective. Integration of (18)F-FET PET has the potential to avoid overtreatment and corresponding costs, as well as unnecessary side effects to the patient.
authors.affiliation: Department of Nuclear Medicine, University of Aachen, Aachen, Germany. aheinzel@ukaachen.de
authors.forename: Alexander
authors.initials: A
authors.lastname: Heinzel
authors.forename: Dirk
authors.initials: D
authors.lastname: Müller
authors.forename: Karl-Josef
authors.initials: KJ
authors.lastname: Langen
authors.forename: Marcus
authors.initials: M
authors.lastname: Blaum
authors.forename: Frederik Anton
authors.initials: FA
authors.lastname: Verburg
authors.forename: Felix M
authors.initials: FM
authors.lastname: Mottaghy
authors.forename: Norbert
authors.initials: N
authors.lastname: Galldiks
mesh_terms: D061067:Antibodies, Monoclonal, Humanized / Q000627:therapeutic use*; D000068258:Bevacizumab; D001932:Brain Neoplasms / Q000000981:diagnostic imaging* / Q000188:drug therapy / Q000473:pathology; D002166:Camptothecin / Q000031:analogs & derivatives* / Q000627:therapeutic use; D003362:Cost-Benefit Analysis; D003663:Decision Trees; D018572:Disease-Free Survival; D005910:Glioma / Q000000981:diagnostic imaging* / Q000188:drug therapy / Q000473:pathology; D006801:Humans; D000077146:Irinotecan; D008279:Magnetic Resonance Imaging; D009010:Monte Carlo Method; D060787:Neoplasm Grading; D049268:Positron-Emission Tomography / Q000191:economics*; D012008:Recurrence; D016896:Treatment Outcome; D014443:Tyrosine / Q000031:analogs & derivatives*
chemical_list: D061067:Antibodies, Monoclonal, Humanized; C545932:(18F)fluoroethyltyrosine; D000068258:Bevacizumab; D014443:Tyrosine; D000077146:Irinotecan; D002166:Camptothecin
keywords: 18F-FET PET; cost-effectiveness analysis; decision tree model; recurrent glioma