O-(2-18F-氟乙基)-L-酪氨酸 PET 用于评估放疗后脑转移复发：有效性和成本效益分析。
O-(2-18F-fluoroethyl)-L-tyrosine PET for evaluation of brain metastasis recurrence after radiotherapy: an effectiveness and cost-effectiveness analysis.
机构信息
Department of Nuclear Medicine, University of Aachen, Aachen, Germany; Institute for Health Economics and Clinical Epidemiology, University of Cologne, Cologne, Germany; Department of Conservative Dentistry, Periodontology and Preventive Dentistry, University of Aachen, Aachen, Germany; Department of Neurology, University of Cologne, Cologne, Germany; Institute for Neuroscience and Medicine, Research Center Juelich, Juelich, Germany; Department of Neuroradiology University of Aachen, Aachen, Germany; Department of Radiation Oncology, University of Cologne, Cologne, Germany; Department of Radiology, University of Bonn, Bonn, Germany; Center of Integrated Oncology (CIO), Universities of Cologne and Bonn, Germany.
出版信息
Neuro Oncol. 2017 Sep 1;19(9):1271-1278. doi: 10.1093/neuonc/now310.
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-(2-18F-fluoroethyl)-L-tyrosine (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 €2821 (baseline scenario) and €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.
背景
常规 MRI 是诊断放射治疗后脑转移复发的标准方法。然而，在放射治疗后，反应性短暂的血脑屏障改变伴随后续的对比增强可模拟脑转移复发。最近的研究表明，O-(2-18F-氟乙基)-L-酪氨酸（FET）PET 可提高脑转移复发与放射损伤的正确区分。基于已发表的证据和临床专家意见，我们分析了在诊断复发性脑转移方面，除 MRI 外，额外使用 FET PET 与单独使用 MRI 的效果和成本效益。
方法
设计了一个决策树模型，从德国法定健康保险（SHI）系统的角度比较了这两种诊断策略。有效性定义为正确诊断复发性脑转移，并将 FET PET 联合 MRI 与单独 MRI 进行比较。为基线情况和更昂贵的情况计算了成本。使用敏感性分析测试了结果的稳健性。
结果
与单独使用 MRI 相比，FET PET 联合 MRI 可将正确诊断率提高 42%（诊断所需人数为 3），增量成本效益比分别为€2821（基线情况）和€4014（更昂贵的情况）。敏感性分析证实了结果的稳健性。
结论
该模型表明，在诊断复发性脑转移方面，常规 MRI 联合 FET PET 的额外使用可能具有成本效益。FET PET 的整合有可能避免过度治疗，从而降低相应的成本和不必要的副作用。
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