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

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.

Cost-Effectiveness Analysis of Local Ablation and Surgery for Liver Metastases of Oligometastatic Colorectal Cancer

“…More recent economic analyses have analyzed the topic of imaging after ablation of liver metastases in mCRC. Schnitzer et al, 2020 examined the cost-effectiveness of follow-up after ablation of colorectal liver metastases by comparing contrast-enhanced CT and 18F-FDG PET/CT, showing that 18F-FDG PET/CT is the costeffective choice for follow-up [7]. In addition, the cost-effectiveness of resection or ablation of other tumor entities has been analyzed.…”

“…In the past, surgery was seen as the gold standard in treatment of liver metastases, as it was regarded as the only approach to achieve a cure. Over the last few years, local ablative therapies, such as radiofrequency ablation (RFA), microwave ablation (MWA) or cryoablation, have complemented the treatment of oligometastatic liver diseases, especially for patient groups that are not suitable for surgery, e.g., older patients with comorbidities or metastases near important vessels [7]. In subgroups, local treatment of oligometastatic disease can even be curative [8].…”

Identify. Quantify. Predict. Why Immunologists Should Widely Use Molecular Imaging for Coronavirus Disease 2019

“…While costs may also be considered a limiting factor for wide application of molecular imaging, cost calculations would have to take into account the potential of costs saved by preventing more severe courses of disease, chronic disease and possible early death. Considering that molecular imaging has been shown to be cost-effective in a variety of cancer conditions (85)(86)(87), it is conceivable that this might equally be the case for COVID-19, where life expectancy and life quality without the event of infection would be unimpaired. Allocation of research funds would thus follow the same principles as in cancer research.…”

Cost-effectiveness analysis in radiology: methods, results and implications

“…Die Strategie einer Verlaufskontrolle mittels 18F-FDG-PET/CT sorgt im Vergleich zur CT trotz initial höheren finanziellen Aufwands für eine deutliche Kostensenkung, da die Kosten einer übersehenen Erkrankung deutlich höher ausfallen. Hierdurch lässt sich nicht nur das Gesamtüberleben verbessern, sondern auch die Gesamtkosten der Behandlung lassen sich effektiv senken [27].…”