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 costeffectiveness ratio of 18 F-FET PET/MR imaging compared with MR imaging alone was V5,725 (V1 $1.30) for the baseline scenario and V8,145 for the more expensive scenario per additional correct diagnosis. The probabilistic sensitivity analysis confirmed the robustness of the results. Conclusion: 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.

The Use of Longitudinal 18F-FET MicroPET Imaging to Evaluate Response to Irinotecan in Orthotopic Human Glioblastoma Multiforme Xenografts

“…Several clinical studies have documented the diagnostic performance of 18 F-FET PET in primary brain tumors, and in conjugation with MRI, 18 F-FET PET has revealed supplementary information on tumor growth and metabolism [6], [34]. Furthermore, a good correlation between 18 F-FET uptake and treatment response has also been demonstrated in clinical studies [5]–[7], [35]. In the present study, we used a patient derived GBM cell line in a murine model and demonstrated the feasibility of monitoring a treatment response with 18 F-FET PET.…”

Amino acid PET in neuro-oncology: applications in the clinic

“…Furthermore, the necessary PET infrastructure is widely available, and the production of radiolabeled amino acids is well established with comparable costs to FDG. Any additional costs of this diagnostic technique can be potentially saved by the incurred costs of less reliable diagnostic imaging techniques [27].…”

The use of amino acid PET and conventional MRI for monitoring of brain tumor therapy

“…Additionally, the cost effectiveness of FET PET for therapy monitoring of antiangiogenic therapy has been analyzed (Heinzel et al, 2013). The data suggest that the additional use of FET PET in the management of these patients have the potential to avoid overtreatment and corresponding costs, as well as unnecessary patient side effects.…”