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
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Rositsa G. Koleva-Kolarova1,2, Marcel J.W. Greuter3, Talitha L. Feenstra1,4, Karin M. Vermeulen1, Erik F.J. de Vries5, David Parkin6, Erik Buskens1 and Geertruida H. de Bock1
1Department of Epidemiology, University of Groningen, University Medical Center Groningen, Groningen, The Netherlands
2School of Population Health Sciences, Faculty of Life Sciences and Medicine and Biomedical Research Center, King’s College London, London, United Kingdom
3Department of Radiology, University of Groningen, University Medical Center Groningen, Groningen, The Netherlands
4National Institute for Public Health and the Environment, Center for Nutrition, Prevention and Health Services Research, Bilthoven, The Netherlands
5Department of Nuclear Medicine and Molecular Imaging, University of Groningen, University Medical Center Groningen, Groningen, The Netherlands
6Department of Economics, City University London, London, United Kingdom
Keywords: breast neoplasm; neoplasm metastasis; diagnostic imaging; positron emission tomography; 89Zr-trastuzumab
Received: October 10, 2017 Accepted: February 24, 2018 Published: April 13, 2018
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.
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