Abstract
Abstract
Purpose
Rectal cancer is one of the most frequent causes of cancer-related morbidity and mortality in the world. Correct identification of the TNM state in primary staging of rectal cancer has critical implications on patient management. Initial evaluations revealed a high sensitivity and specificity for whole-body PET/MRI in the detection of metastases allowing for metastasis-directed therapy regimens. Nevertheless, its cost-effectiveness compared with that of standard-of-care imaging (SCI) using pelvic MRI + chest and abdominopelvic CT is yet to be investigated. Therefore, the aim of this study was to analyze the cost-effectiveness of whole-body 18F FDG PET/MRI as an alternative imaging method to standard diagnostic workup for initial staging of rectal cancer.
Methods
For estimation of quality-adjusted life years (QALYs) and lifetime costs of diagnostic modalities, a decision model including whole-body 18F FDG PET/MRI with a hepatocyte-specific contrast agent and pelvic MRI + chest and abdominopelvic CT was created based on Markov simulations. For obtaining model input parameters, review of recent literature was performed. Willingness to pay (WTP) was set to $100,000/QALY. Deterministic sensitivity analysis of diagnostic parameters and costs was applied, and probabilistic sensitivity was determined using Monte Carlo modeling.
Results
In the base-case scenario, the strategy whole-body 18F FDG PET/MRI resulted in total costs of $52,186 whereas total costs of SCI were at $51,672. Whole-body 18F FDG PET/MRI resulted in an expected effectiveness of 3.542 QALYs versus 3.535 QALYs for SCI. This resulted in an incremental cost-effectiveness ratio of $70,291 per QALY for PET/MRI. Thus, from an economic point of view, whole-body 18F FDG PET/MRI was identified as an adequate diagnostic alternative to SCI with high robustness of results to variation of input parameters.
Conclusion
Based on the results of the analysis, use of whole-body 18F FDG PET/MRI was identified as a feasible diagnostic strategy for initial staging of rectal cancer from a cost-effectiveness perspective.
Publisher
Springer Science and Business Media LLC
Subject
Radiology Nuclear Medicine and imaging,General Medicine,Radiology Nuclear Medicine and imaging,General Medicine
Reference31 articles.
1. Noone AM HN, Krapcho M, Miller D, Brest A, Yu M, Ruhl J, Tatalovich Z, Mariotto A, Lewis DR, Chen HS, Feuer EJ, Cronin KA SEER cancer statistics review, 1975-2015, National Cancer Institute. Bethesda, MD, https://seer.cancer.gov/csr/1975_2015/, based on November 2017 SEER data submission, posted to the SEER web site, April 2018. 2018.
2. Kurilova I, Gonzalez-Aguirre A, Beets-Tan RG, Erinjeri J, Petre EN, Gonen M, et al. Microwave Ablation in the management of colorectal cancer pulmonary metastases. Cardiovasc Intervent Radiol. 2018;41:1530–44. https://doi.org/10.1007/s00270-018-2000-6.
3. Kelly CM, Kemeny NE. Liver-directed therapy in metastatic colorectal cancer. Expert Rev Anticancer Ther. 2017;17:745–58. https://doi.org/10.1080/14737140.2017.1345629.
4. Das S, Ciombor KK, Haraldsdottir S, Goldberg RM. Promising new agents for colorectal cancer. Curr Treat Options in Oncol. 2018;19:29. https://doi.org/10.1007/s11864-018-0543-z.
5. Tan HL, Lee M, Vellayappan BA, Neo WT, Yong WP. The role of liver-directed therapy in metastatic colorectal cancer. Curr Colorect Cancer Rep. 2018;14:129–37. https://doi.org/10.1007/s11888-018-0409-6.
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