Cost-effectiveness of the implementation of [68Ga]Ga-PSMA-11 PET/CT at initial prostate cancer staging
Abstract Background Despite its high specificity, PSMA PET/CT has a moderate to low sensitivity of 40–50% for pelvic lymph node detection, implicating that a negative PSMA PET/CT cannot rule out lymph node metastases. This study investigates a strategy of implementing PSMA PET/CT for initial prostat...
| Main Authors: | , , , , , , , , , |
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| Format: | Article |
| Language: | English |
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SpringerOpen
2022-08-01
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| Series: | Insights into Imaging |
| Subjects: | |
| Online Access: | https://doi.org/10.1186/s13244-022-01265-w |
| _version_ | 1811215490610102272 |
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| author | Esmée C. A. van der Sar Willem R. Keusters Ludwike W. M. van Kalmthout Arthur J. A. T. Braat Bart de Keizer Geert W. J. Frederix Anko Kooistra Jules Lavalaye Marnix G. E. H. Lam Harm H. E. van Melick |
| author_facet | Esmée C. A. van der Sar Willem R. Keusters Ludwike W. M. van Kalmthout Arthur J. A. T. Braat Bart de Keizer Geert W. J. Frederix Anko Kooistra Jules Lavalaye Marnix G. E. H. Lam Harm H. E. van Melick |
| author_sort | Esmée C. A. van der Sar |
| collection | DOAJ |
| description | Abstract Background Despite its high specificity, PSMA PET/CT has a moderate to low sensitivity of 40–50% for pelvic lymph node detection, implicating that a negative PSMA PET/CT cannot rule out lymph node metastases. This study investigates a strategy of implementing PSMA PET/CT for initial prostate cancer staging and treatment planning compared to conventional diagnostics. In this PSMA PET/CT strategy, a bilateral extended pelvic lymph node dissection (ePLND) is only performed in case of a negative PSMA PET/CT; in case of a positive scan treatment planning is solely based on PSMA PET/CT results. Method A decision table and lifetime state transition model were created. Quality-adjusted life years and health care costs were modelled over lifetime. Results The PSMA PET/CT strategy of treatment planning based on initial staging with [68Ga]Ga-PSMA-11 PET/CT results in cost-savings of €674 and a small loss in quality of life (QoL), 0.011 QALY per patient. The positive effect of [68Ga]Ga-PSMA-11 PET/CT was caused by abandoning both an ePLND and unnecessary treatment in iM1 patients, saving costs and resulting in higher QoL. The negative effect was caused by lower QoL and high costs in the false palliative state, due to pN1lim patients (≤ 4 pelvic lymph node metastases) being falsely diagnosed as iN1ext (> 4 pelvic lymph node metastases). These patients received subsequently palliative treatment instead of potentially curative therapy. Conclusion Initial staging and treatment planning based on [68Ga]Ga-PSMA-11 PET/CT saves cost but results in small QALY loss due to the rate of false positive findings. |
| first_indexed | 2024-04-12T06:23:31Z |
| format | Article |
| id | doaj.art-30d4b65dc6fe4c3aa4938473ca1e579d |
| institution | Directory Open Access Journal |
| issn | 1869-4101 |
| language | English |
| last_indexed | 2024-04-12T06:23:31Z |
| publishDate | 2022-08-01 |
| publisher | SpringerOpen |
| record_format | Article |
| series | Insights into Imaging |
| spelling | doaj.art-30d4b65dc6fe4c3aa4938473ca1e579d2022-12-22T03:44:13ZengSpringerOpenInsights into Imaging1869-41012022-08-0113111010.1186/s13244-022-01265-wCost-effectiveness of the implementation of [68Ga]Ga-PSMA-11 PET/CT at initial prostate cancer stagingEsmée C. A. van der Sar0Willem R. Keusters1Ludwike W. M. van Kalmthout2Arthur J. A. T. Braat3Bart de Keizer4Geert W. J. Frederix5Anko Kooistra6Jules Lavalaye7Marnix G. E. H. Lam8Harm H. E. van Melick9Department of Radiology and Nuclear Medicine, University Medical Center UtrechtJulius Center, University Medical Center UtrechtDepartment of Radiotherapy, University Medical Center UtrechtDepartment of Radiology and Nuclear Medicine, University Medical Center UtrechtDepartment of Radiology and Nuclear Medicine, University Medical Center UtrechtJulius Center, University Medical Center UtrechtDepartment of Urology, Meander Medical CenterDepartment of Nuclear Medicine, St Antonius HospitalDepartment of Radiology and Nuclear Medicine, University Medical Center UtrechtDepartment of Urology, St Antonius HospitalAbstract Background Despite its high specificity, PSMA PET/CT has a moderate to low sensitivity of 40–50% for pelvic lymph node detection, implicating that a negative PSMA PET/CT cannot rule out lymph node metastases. This study investigates a strategy of implementing PSMA PET/CT for initial prostate cancer staging and treatment planning compared to conventional diagnostics. In this PSMA PET/CT strategy, a bilateral extended pelvic lymph node dissection (ePLND) is only performed in case of a negative PSMA PET/CT; in case of a positive scan treatment planning is solely based on PSMA PET/CT results. Method A decision table and lifetime state transition model were created. Quality-adjusted life years and health care costs were modelled over lifetime. Results The PSMA PET/CT strategy of treatment planning based on initial staging with [68Ga]Ga-PSMA-11 PET/CT results in cost-savings of €674 and a small loss in quality of life (QoL), 0.011 QALY per patient. The positive effect of [68Ga]Ga-PSMA-11 PET/CT was caused by abandoning both an ePLND and unnecessary treatment in iM1 patients, saving costs and resulting in higher QoL. The negative effect was caused by lower QoL and high costs in the false palliative state, due to pN1lim patients (≤ 4 pelvic lymph node metastases) being falsely diagnosed as iN1ext (> 4 pelvic lymph node metastases). These patients received subsequently palliative treatment instead of potentially curative therapy. Conclusion Initial staging and treatment planning based on [68Ga]Ga-PSMA-11 PET/CT saves cost but results in small QALY loss due to the rate of false positive findings.https://doi.org/10.1186/s13244-022-01265-wProstate cancerPSMA PET/CTCost-effectivenessRadioligandGallium |
| spellingShingle | Esmée C. A. van der Sar Willem R. Keusters Ludwike W. M. van Kalmthout Arthur J. A. T. Braat Bart de Keizer Geert W. J. Frederix Anko Kooistra Jules Lavalaye Marnix G. E. H. Lam Harm H. E. van Melick Cost-effectiveness of the implementation of [68Ga]Ga-PSMA-11 PET/CT at initial prostate cancer staging Insights into Imaging Prostate cancer PSMA PET/CT Cost-effectiveness Radioligand Gallium |
| title | Cost-effectiveness of the implementation of [68Ga]Ga-PSMA-11 PET/CT at initial prostate cancer staging |
| title_full | Cost-effectiveness of the implementation of [68Ga]Ga-PSMA-11 PET/CT at initial prostate cancer staging |
| title_fullStr | Cost-effectiveness of the implementation of [68Ga]Ga-PSMA-11 PET/CT at initial prostate cancer staging |
| title_full_unstemmed | Cost-effectiveness of the implementation of [68Ga]Ga-PSMA-11 PET/CT at initial prostate cancer staging |
| title_short | Cost-effectiveness of the implementation of [68Ga]Ga-PSMA-11 PET/CT at initial prostate cancer staging |
| title_sort | cost effectiveness of the implementation of 68ga ga psma 11 pet ct at initial prostate cancer staging |
| topic | Prostate cancer PSMA PET/CT Cost-effectiveness Radioligand Gallium |
| url | https://doi.org/10.1186/s13244-022-01265-w |
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