Cost-Effectiveness of [18F] Fluoroethyl-L-Tyrosine for Temozolomide Therapy Assessment in Patients With Glioblastoma

Abstract

Background and Purpose: Glioblastomas are the most aggressive of all gliomas. The prognosis of these gliomas, which are classified as grade IV tumors by the World Health Organization (WHO), is poor. Combination therapy, including surgery, radiotherapy, and chemotherapy has variable outcomes and is expensive. In light of rising healthcare costs, there are societal demands for the justification of medical expenses. Therefore, we calculated the cost-effectiveness of follow-up [ 18 F] fluoroethyl-L-tyrosine ([ 18 F] FET) positron emission tomography (PET) scans performed on patients with glioblastoma after surgery and before commencing temozolomide maintenance treatment. Materials and Methods: To determine the cost-effectiveness of follow-up [ 18 F] FET PET procedures, we examined published clinical data and calculated the associated costs in the context of Belgian healthcare. We subsequently performed one-way deterministic sensitivity analysis and Monte Carlo analysis on the calculated ratios. Results: The decision tree based on overall survival rates showed that the number of non-responders identified using PET was 57.14% higher than the number of non-responders identified using conventional MRI. Further, the decision tree based on progression-free survival rates revealed a comparable increase of 57.50% non-responders identified. The calculated cost of two required PET scans per patient during the follow-up treatment phase was 780.50 euros. Two cost-effectiveness ratios were determined for overall survival and progression-free survival rates. Both of these calculations yielded very similar results: incremental cost-effectiveness ratios of 1,365.86 and 1,357.38 euros, respectively, for each identified non-responder. The findings of the sensitivity analysis supported the calculated results, confirming that the obtained data were robust. Conclusion: Our comparative study of conventional MRI and [ 18 F] FET PET revealed that the latter is a valuable tool for predicting the treatment responses of patients with glioblastomas to follow-up temozolomide maintenance treatment while considering its cost-effectiveness. Thus, [ 18 F] FET PET scans enable clinical outcomes to be predicted accurately and at a low cost. Moreover, given the robustness of the data in the sensitivity analyses, the level of certainty of this outcome is acceptable.

Evaluation of the Cost-Effectiveness of Iron Formulations for the Treatment of Iron Deficiency Anaemia in Patients with Inflammatory Bowel Disease in the UK

“… 38 Similar analyses have also been conducted to evaluate treatments for glioblastoma, rheumatoid and psoriatic arthritis, chronic obstructive pulmonary disease, chronic immune thrombocytopenia, psoriasis. 39 – 43 These analyses provide a precedent for the present modelling approach, and provide some context to the results.…”

Iron Formulations for the Treatment of Iron Deficiency Anemia in Patients with Inflammatory Bowel Disease: A Cost-Effectiveness Analysis in Switzerland

“…Cost per responder and cost per remitter varied with the differing interventions, with the modelling analysis suggesting that the additional cost per additional responder was USD 116,291 for adalimumab versus placebo and USD 125,169 for infliximab versus placebo, and that the additional cost per additional remitter was USD 121,863 for adalimumab versus placebo and USD 174,846 for infliximab versus placebo. However, such analyses are not limited to IBD, with cost per responder analyses previously conducted to assess the cost-effectiveness of treatments for glioblastoma, rheumatoid and psoriatic arthritis, chronic obstructive pulmonary disease, chronic immune thrombocytopenia, and psoriasis [49][50][51][52][53].…”

Application of Metabolic Reprogramming to Cancer Imaging and Diagnosis

“…In current glioblastoma treatments, temozolomide (TMZ) is considered the standard chemotherapy regimen for patients, but it leads to drug resistance and survival prolongation is limited. However, 18 F-FET may be a valuable tool for predicting the outcome of therapy before the commencement of TMZ maintenance therapy [120]. Merging this evidence, 18 F-FET has been identified as having a good diagnostic performance for the initial assessment of patients with new isolated brain lesions [121].…”