Universität zu Köln

Heinzel, Alexander ORCID: 0000-0002-2430-4557, Mueller, Dirk, Yekta-Michael, Sareh Said, Ceccon, Garry, Langen, Karl-Josef ORCID: 0000-0003-1101-5075, Mottaghy, Felix M., Wiesmann, Martin, Kocher, Martin, Hattingen, Elke ORCID: 0000-0002-8392-9004 and Galldiks, Norbert ORCID: 0000-0002-2485-1796 (2017). O-(2-F-18-fluoroethyl)-L-tyrosine PET for evaluation of brain metastasis recurrence after radiotherapy: an effectiveness and cost-effectiveness analysis. Neuro-Oncology, 19 (9). S. 1271 - 1279. CARY: OXFORD UNIV PRESS INC. ISSN 1523-5866

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Abstract

Background. Conventional MRI is the standard method to diagnose recurrence of brain metastases after radiation. However, following radiation therapy, reactive transient blood-brain barrier alterations with consecutive contrast enhancement can mimic brain metastasis recurrence. Recent studies have suggested that O-(2-F-18-fluoroethyl)-Ltyrosine (FET) PET improves the correct differentiation of brain metastasis recurrence from radiation injury. Based on published evidence and clinical expert opinion, we analyzed effectiveness and cost-effectiveness of the use of FET PET in addition to MRI compared with MRI alone for the diagnosis of recurrent brain metastases. Methods. A decision-tree model was designed to compare the 2 diagnostic strategies from the perspective of the German Statutory Health Insurance (SHI) system. Effectiveness was defined as correct diagnosis of recurrent brain metastasis and was compared between FET PET with MRI and MRI alone. Costs were calculated for a baseline scenario and for a more expensive scenario. Robustness of the results was tested using sensitivity analyses. Results. Compared with MRI alone, FET PET in combination with MRI increases the rate of correct diagnoses by 42% (number needed to diagnose of 3) with an incremental cost-effectiveness ratio of is an element of 2821 (baseline scenario) and is an element of 4014 (more expensive scenario) per correct diagnosis. The sensitivity analyses confirmed the robustness of the results. Conclusions. The model suggests that the additional use of FET PET with conventional MRI for the diagnosis of recurrent brain metastases may be cost-effective. Integration of FET PET has the potential to avoid overtreatment with corresponding costs as well as unnecessary side effects.

Item Type:	Journal Article
Creators:	Creators Email ORCID ORCID Put Code Heinzel, Alexander UNSPECIFIED orcid.org/0000-0002-2430-4557 UNSPECIFIED Mueller, Dirk UNSPECIFIED UNSPECIFIED UNSPECIFIED Yekta-Michael, Sareh Said UNSPECIFIED UNSPECIFIED UNSPECIFIED Ceccon, Garry UNSPECIFIED UNSPECIFIED UNSPECIFIED Langen, Karl-Josef UNSPECIFIED orcid.org/0000-0003-1101-5075 UNSPECIFIED Mottaghy, Felix M. UNSPECIFIED UNSPECIFIED UNSPECIFIED Wiesmann, Martin UNSPECIFIED UNSPECIFIED UNSPECIFIED Kocher, Martin UNSPECIFIED UNSPECIFIED UNSPECIFIED Hattingen, Elke UNSPECIFIED orcid.org/0000-0002-8392-9004 UNSPECIFIED Galldiks, Norbert UNSPECIFIED orcid.org/0000-0002-2485-1796 UNSPECIFIED
URN:	urn:nbn:de:hbz:38-221032
DOI:	10.1093/neuonc/now310
Journal or Publication Title:	Neuro-Oncology
Volume:	19
Number:	9
Page Range:	S. 1271 - 1279
Date:	2017
Publisher:	OXFORD UNIV PRESS INC
Place of Publication:	CARY
ISSN:	1523-5866
Language:	English
Faculty:	Unspecified
Divisions:	Unspecified
Subjects:	no entry
Uncontrolled Keywords:	Keywords Language POSITRON-EMISSION-TOMOGRAPHY; RESPONSE ASSESSMENT CRITERIA; HIGH-GRADE GLIOMA; RADIATION NECROSIS; STEREOTACTIC RADIOSURGERY; WORKING GROUP; TUMORS; DIFFERENTIATION; NEUROONCOLOGY; F-18-DOPA Multiple languages Oncology; Clinical Neurology Multiple languages
Refereed:	Yes
URI:	http://kups.ub.uni-koeln.de/id/eprint/22103