Cost-Effectiveness Analysis of <sup>68</sup>Ga DOTA-TATE PET/CT, <sup>111</sup>In-Pentetreotide SPECT/CT and CT for Diagnostic Workup of Neuroendocrine Tumors
Matthias Frank Froelich,
Moritz Ludwig Schnitzer,
Adrien Holzgreve,
Felix Gerhard Gassert,
Eva Gresser,
Daniel Overhoff,
Vincent Schwarze,
Matthias Philipp Fabritius,
Dominik Nörenberg,
Niklas von Münchhausen,
Nils Große Hokamp,
Christoph J. Auernhammer,
Harun Ilhan,
Andrei Todica,
Johannes Rübenthaler
Affiliations
Matthias Frank Froelich
Department of Radiology and Nuclear Medicine, University Medical Center Mannheim, Theodor-Kutzer-Ufer 1-3, 68167 Mannheim, Germany
Moritz Ludwig Schnitzer
Department of Radiology, University Hospital, LMU Munich, Marchioninistr. 15, 81377 Munich, Germany
Adrien Holzgreve
ENETS Centre of Excellence, Interdisciplinary Center of Neuroendocrine Tumors of the GastroEnteroPancreatic System (GEPNET-KUM), LMU Munich, 81377 Munich, Germany
Felix Gerhard Gassert
Department of Diagnostic and Interventional Radiology, Klinikum rechts der Isar, Technical University of Munich, Ismaninger Str. 22, 81675 Munich, Germany
Eva Gresser
Department of Radiology, University Hospital, LMU Munich, Marchioninistr. 15, 81377 Munich, Germany
Daniel Overhoff
Department of Radiology and Nuclear Medicine, University Medical Center Mannheim, Theodor-Kutzer-Ufer 1-3, 68167 Mannheim, Germany
Vincent Schwarze
Department of Radiology, University Hospital, LMU Munich, Marchioninistr. 15, 81377 Munich, Germany
Matthias Philipp Fabritius
Department of Radiology, University Hospital, LMU Munich, Marchioninistr. 15, 81377 Munich, Germany
Dominik Nörenberg
Department of Radiology and Nuclear Medicine, University Medical Center Mannheim, Theodor-Kutzer-Ufer 1-3, 68167 Mannheim, Germany
Niklas von Münchhausen
Department of Radiology and Nuclear Medicine, University Medical Center Mannheim, Theodor-Kutzer-Ufer 1-3, 68167 Mannheim, Germany
Nils Große Hokamp
Institute for Diagnostic and Interventional Radiology, University Hospital Cologne, 50937 Cologne, Germany
Christoph J. Auernhammer
ENETS Centre of Excellence, Interdisciplinary Center of Neuroendocrine Tumors of the GastroEnteroPancreatic System (GEPNET-KUM), LMU Munich, 81377 Munich, Germany
Harun Ilhan
ENETS Centre of Excellence, Interdisciplinary Center of Neuroendocrine Tumors of the GastroEnteroPancreatic System (GEPNET-KUM), LMU Munich, 81377 Munich, Germany
Andrei Todica
ENETS Centre of Excellence, Interdisciplinary Center of Neuroendocrine Tumors of the GastroEnteroPancreatic System (GEPNET-KUM), LMU Munich, 81377 Munich, Germany
Johannes Rübenthaler
Department of Radiology, University Hospital, LMU Munich, Marchioninistr. 15, 81377 Munich, Germany
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.
