Cost-Effectiveness Analysis of 68Ga DOTA-TATE PET/CT, 111In-Pentetreotide SPECT/CT and CT for Diagnostic Workup of Neuroendocrine Tumors

Abstract

Neuroendocrine tumors (NETs) are relatively rare neoplasms arising from the hormone-producing neuroendocrine system that can occur in various organs such as pancreas, small bowel, stomach and lung. As the majority of these tumors express somatostatin receptors (SSR) on their cell membrane, utilization of SSR analogs in nuclear medicine is a promising, but relatively costly approach for detection and localization. The aim of this study was to analyze the cost-effectiveness of 68Ga-DOTA-TATE PET/CT (Gallium-68 DOTA-TATE Positron emission tomography/computed tomography) compared to 111In-pentetreotide SPECT/CT (Indium-111 pentetreotide Single Photon emission computed tomography/computed tomography) and to CT (computed tomography) alone in detection of NETs. A decision model on the basis of Markov simulations evaluated lifetime costs and quality-adjusted life years (QALYs) related to either a CT, SPECT/CT or PET/CT. Model input parameters were obtained from publicized research projects. The analysis is grounded on the US healthcare system. Deterministic sensitivity analysis of diagnostic parameters and probabilistic sensitivity analysis predicated on a Monte Carlo simulation with 30,000 reiterations was executed. The willingness-to-pay (WTP) was determined to be $ 100,000/QALY. In the base-case investigation, PET/CT ended up with total costs of $88,003.07 with an efficacy of 4.179, whereas CT ended up with total costs of $88,894.71 with an efficacy of 4.165. SPECT/CT ended up with total costs of $89,973.34 with an efficacy of 4.158. Therefore, the strategies CT and SPECT/CT were dominated by PET/CT in the base-case scenario. In the sensitivity analyses, PET/CT remained a cost-effective strategy. This result was due to reduced therapy costs of timely detection. The additional costs of 68Ga-DOTA-TATE PET/CT when compared to CT alone are justified in the light of potential savings in therapy costs and better outcomes.

PET with Different Radiopharmaceuticals in Neuroendocrine Neoplasms: An Umbrella Review of Published Meta-Analyses

“…Even if the cost-effectiveness of PET imaging in neuroendocrine neoplasms was not evaluated by specific meta-analyses, a recent study comparing 68 Ga-SSA PET/CT, SSR SPECT/CT and CT underlined that the use of 68 Ga-SSA PET/CT in NETs is cost-effective. The additional costs of 68 Ga-SSA PET/CT, when compared to CT alone, are justified in the light of potential savings in therapy costs and better outcomes [51].…”

Molecular Genomic Assessment Using a Blood-based mRNA Signature (NETest) is Cost-effective and Predicts Neuroendocrine Tumor Recurrence With 94% Accuracy

“…F, The cost of detecting a recurrence was $22% higher in the SoC evaluated cohort ($USD57,250) than the NETest cohort ($USD44,600). 12,13,25 þNETest indicates follow-up strategy that utilizes a POD30 NETest-based stratification.…”

Imaging alloreactive T cells provides early warning of organ transplant rejection

“…Several recent studies reported that new imaging tracers targeting cell surface molecules such as Ga 68 -PSMA or Ga 68 -DOTATATE PET might improve cost effectiveness ( 63 – 65 ), whereas product cost themselves are relatively expensive. OX40 immunoPET might be expensive compared with standard examinations in the clinic.…”