Bicu Felix, Rink Johann S, Froelich Matthias F, Cyran Clemens C, Rübenthaler Johannes, Birgin Emrullah, Röhrich Manuel, Tollens Fabian
Department of Nuclear Medicine, University Hospital Heidelberg, D-68120 Heidelberg, Germany.
Department of Radiology and Nuclear Medicine, University Medical Center Mannheim, Theodor-Kutzer-Ufer 1-3, D-68167 Mannheim, Germany.
Cancers (Basel). 2021 Mar 18;13(6):1365. doi: 10.3390/cancers13061365.
Accurate detection of malignant transformation and risk-stratification of intraductal papillary mucinous neoplasms (IPMN) has remained a diagnostic challenge. Preliminary findings have indicated a promising role of positron emission tomography combined with computed tomography and F-fluorodeoxyglucose (F-FDG-PET/CT) in detecting malignant IPMN. Therefore, the aim of this model-based economic evaluation was to analyze whether supplemental FDG-PET/CT could be cost-effective in patients with IPMN. Decision analysis and Markov modeling were applied to simulate patients' health states across a time frame of 15 years. CT/MRI based imaging was compared to a strategy with supplemental F-FDG-PET/CT. Cumulative costs in US-$ and outcomes in quality-adjusted life years (QALY) were computed based on input parameters extracted from recent literature. The stability of the model was evaluated by deterministic sensitivity analyses. In the base-case scenario, the CT/MRI-strategy resulted in cumulative discounted costs of USD $106,424 and 8.37 QALYs, while the strategy with supplemental FDG-PET/CT resulted in costs of USD $104,842 and a cumulative effectiveness of 8.48 QALYs and hence was cost-saving. A minimum specificity of FDG-PET/CT of 71.5% was required for the model to yield superior net monetary benefits compared to CT/MRI. This model-based economic evaluation indicates that supplemental F-FDG-PET/CT could have a favorable economic value in the management of IPMN and could be cost-saving in the chosen setting. Prospective studies with standardized protocols for FDG-PET/CT could help to better determine the value of FDG-PET/CT.
准确检测导管内乳头状黏液性肿瘤（IPMN）的恶性转化和风险分层仍然是一项诊断挑战。初步研究结果表明，正电子发射断层扫描结合计算机断层扫描和F-氟脱氧葡萄糖（F-FDG-PET/CT）在检测恶性IPMN方面具有潜在作用。因此，本基于模型的经济评估旨在分析补充FDG-PET/CT对IPMN患者是否具有成本效益。应用决策分析和马尔可夫模型来模拟患者在15年时间范围内的健康状态。将基于CT/MRI的成像与补充F-FDG-PET/CT的策略进行比较。根据从近期文献中提取的输入参数计算以美元为单位的累积成本和质量调整生命年（QALY）的结果。通过确定性敏感性分析评估模型的稳定性。在基础案例中，CT/MRI策略导致累积贴现成本为106,424美元和8.37个QALY，而补充FDG-PET/CT的策略导致成本为104,842美元和累积效益为8.48个QALY，因此具有成本节约效果。与CT/MRI相比，模型要产生更高的净货币效益，FDG-PET/CT的最低特异性需达到71.5%。本基于模型的经济评估表明，补充F-FDG-PET/CT在IPMN的管理中可能具有良好的经济价值，并且在所选环境中可能具有成本节约效果。采用标准化FDG-PET/CT方案的前瞻性研究有助于更好地确定FDG-PET/CT的价值。
