From the Department of Radiology (J.R., M.R., A.H., S.K., G. Madera, J.R.O., E.L., J.I.).
Siemens Healthineers (G. Martinez), Malvern, Pennsylvania.
AJNR Am J Neuroradiol. 2023 Jul;44(7):783-791. doi: 10.3174/ajnr.A7901. Epub 2023 Jun 8.
While contrast-enhanced MR imaging is the criterion standard in meningioma diagnosis and treatment response assessment, gallium Ga-DOTATATE PET/MR imaging has increasingly demonstrated utility in meningioma diagnosis and management. Integrating Ga-DOTATATE PET/MR imaging in postsurgical radiation planning reduces the planning target volume and organ-at-risk dose. However, Ga-DOTATATE PET/MR imaging is not widely implemented in clinical practice due to higher perceived costs. Our study analyzes the cost-effectiveness of Ga-DOTATATE PET/MR imaging for postresection radiation therapy planning in patients with intermediate-risk meningioma.
We developed a decision-analytical model based on both recommended guidelines on meningioma management and our institutional experience. Markov models were implemented to estimate quality-adjusted life-years (QALY). Cost-effectiveness analyses with willingness-to-pay thresholds of $50,000/QALY and $100,000/QALY were performed from a societal perspective. Sensitivity analyses were conducted to validate the results. Model input values were based on published literature.
The cost-effectiveness results demonstrated that Ga-DOTATATE PET/MR imaging yields higher QALY (5.47 versus 5.05) at a higher cost ($404,260 versus $395,535) compared with MR imaging alone. The incremental cost-effectiveness ratio analysis determined that Ga-DOTATATE PET/MR imaging is cost-effective at a willingness to pay of $50,000/QALY and $100,000/QALY. Furthermore, sensitivity analyses showed that Ga-DOTATATE PET/MR imaging is cost-effective at $50,000/QALY ($100,000/QALY) for specificity and sensitivity values above 76% (58%) and 53% (44%), respectively.
Ga-DOTATATE PET/MR imaging as an adjunct imaging technique is cost-effective in postoperative treatment planning in patients with meningiomas. Most important, the model results show that the sensitivity and specificity cost-effective thresholds of Ga-DOTATATE PET/MR imaging could be attained in clinical practice.
虽然对比增强磁共振成像（MRI）是脑膜瘤诊断和治疗反应评估的标准，但镓 Ga-DOTATATE PET/MRI 成像在脑膜瘤的诊断和管理中越来越显示出其作用。在术后放射治疗计划中整合 Ga-DOTATATE PET/MRI 成像可以减少计划靶区和危及器官的剂量。然而，由于 Ga-DOTATATE PET/MRI 成像的成本较高，因此并未广泛应用于临床实践。本研究分析了 Ga-DOTATATE PET/MRI 成像在后颅窝脑膜瘤切除术后放疗计划中的成本效益。
我们基于脑膜瘤管理的推荐指南和我们机构的经验，开发了一个决策分析模型。采用马尔可夫模型来估计质量调整生命年（QALY）。从社会角度进行了成本效益分析，采用支付意愿阈值为 50000 美元/QALY 和 100000 美元/QALY。进行了敏感性分析以验证结果。模型输入值基于已发表的文献。
成本效益结果表明，与单独使用 MRI 相比，Ga-DOTATATE PET/MRI 成像具有更高的 QALY（5.47 比 5.05），但成本也更高（404260 美元比 395535 美元）。增量成本效益比分析确定，在支付意愿为 50000 美元/QALY 和 100000 美元/QALY 时，Ga-DOTATATE PET/MRI 成像具有成本效益。此外，敏感性分析表明，对于特异性和敏感性值分别高于 76%（58%）和 53%（44%）时，Ga-DOTATATE PET/MRI 成像在 50000 美元/QALY（100000 美元/QALY）时具有成本效益。
Ga-DOTATATE PET/MRI 成像作为一种辅助成像技术，在脑膜瘤患者的术后治疗计划中具有成本效益。最重要的是，模型结果表明，Ga-DOTATATE PET/MRI 成像的敏感性和特异性成本效益阈值可能在临床实践中达到。
