Molecular imaging with positron emission tomography and computed tomography (PET/CT) for selecting first-line targeted treatment in metastatic breast cancer: a cost-effectiveness study

Abstract

Our aim was to evaluate the potential cost-effectiveness of PET/CT with FES and 89Zr-trastuzumab compared to pathology to select first-line targeted treatment in metastatic breast cancer (MBC) patients with non-rapidly progressive disease. A previously published and validated model was extended and adapted for this analysis. Two alternative scenarios were compared. In the care as usual pathway first-line targeted treatment of MBC patients was assigned on the basis of pathology results, while in the intervention pathway treatment selection was based on the results from the PET/CT imaging. Costs, life years gained (LYG) and incremental cost-effectiveness ratios (ICER) were calculated. More MBC lesions were detected in the intervention pathway than in the care as usual pathway. The diagnostic costs to evaluate the receptor status and the treatment costs were higher in the intervention strategy, as were total costs and total LYG. The ICER for replacing biopsies with PET/CT imaging with FES and 89Zr-trastuzumab, assuming sensitivity of 77.1% and specificity of 80%, ranged from €71,000 to €77,000 per LYG. When assuming sensitivity of 80% and specificity of 76.7%, the ICER for replacing biopsies with PET/CT imaging with FES and 89Zr-trastuzumab ranged from to €74,000 to €80,000 per LYG. The application of PET/CT with FES and 89Zr-trastuzumab in first-line treatment selection for MBC patients has the potential to be a cost-effective intervention. Our analysis demonstrated that even a small increase in the sensitivity and the specificity of PET/CT can have a large impact on its potential cost-effectiveness.

Application of PET Tracers in Molecular Imaging for Breast Cancer

“…Two computer simulation studies described the impact of [ 18 F]-FES-PET/CT on health-related measurements, such as life years gained (LYG), ICER, and total costs (Table 1) [55,56]. One study selected first-line treatment in MBC patients based on biopsy results or [ 18 F]-FES-PET/CT imaging findings and showed higher diagnostic and treatment costs in the PET/CT imaging group [56].…”

“…Two computer simulation studies described the impact of [ 18 F]-FES-PET/CT on health-related measurements, such as life years gained (LYG), ICER, and total costs (Table 1) [55,56]. One study selected first-line treatment in MBC patients based on biopsy results or [ 18 F]-FES-PET/CT imaging findings and showed higher diagnostic and treatment costs in the PET/CT imaging group [56]. A second study determined the number of avoided biopsies to assess MBC after the introduction of [ 18 F]-FES-PET/CT and showed that the number of biopsies (39 ± 9%) was lower in the [ 18 F]-FES-PET/CT imaging group [55].…”

“…A computer simulated study of a hypothetical cohort of 1000 MBC patients assessed whether [ 89 Zr]-trastuzumab-PET/CT could replace biopsy [56]. This study concluded that total costs were higher with [ 89 Zr]-trastuzumab-PET/CT.…”

Long non‑coding RNA SNHG1 promotes breast cancer progression by regulation of LMO4

“…Tumor metastasis is considered a major mortality cause in breast cancer patients (31). To investigate whether SNHG1 regulates breast cancer cell migration, wound healing assays were performed to detect cell migration following SNHG1 knockdown.…”

Exploring Tumor Heterogeneity Using PET Imaging: The Big Picture

“…Breast cancer also represents a great model for this type of approach [12,13]. Indeed, in this pathology, 18F-fluoroestradiol (FES) PET has been validated as an accurate method for providing information on estrogen receptor (ER) status of tumor lesions to determine need for endocrine therapy [14,15,16,17].…”