Rosen Jurij, Werner Jan-Michael, Ceccon Garry S, Rosen Elena K, Wollring Michael M, Stetter Isabelle, Lohmann Philipp, Mottaghy Felix M, Marner Lisbeth, Law Ian, Fink Gereon R, Langen Karl-Josef, Galldiks Norbert
Department of Psychiatry, Faculty of Medicine and University Hospital Cologne, University of Cologne, Cologne, Germany.
Department of Neurology, Faculty of Medicine and University Hospital Cologne, University of Cologne, Kerpener St. 62, 50937, Cologne, Germany.
Eur J Nucl Med Mol Imaging. 2025 Jun 4. doi: 10.1007/s00259-025-07377-x.
PET using the radiolabeled amino acid O-(2-[F]-fluoroethyl)-L-tyrosine ([F]FET) has considerable clinical value for follow-up evaluation of central nervous system tumors in children and adolescents. As medical procedures must be justified socio-economically, we determined cost-effectiveness of [F]FET PET for identification of treatment-related changes.
We analyzed clinical data from two different studies that assessed the value of FET PET to differentiate between brain and spinal tumor relapse and treatment-related changes in children and adolescents. Cost calculation was based on the German statutory health insurance system perspective. Due to subtle differences in the diagnostic approach of the studies, two separate clinical scenarios including 80 patients with 105 lesions were considered: Decision tree model 1 determined cost-effectiveness of simultaneous [F]FET PET and MRI in comparison to MRI alone to identify treatment-related changes. Decision tree model 2 determined cost-effectiveness of [F]FET PET alone to identify treatment-related changes when routine MRI findings were suspicious for tumor relapse. Deterministic and probabilistic sensitivity analyses tested the robustness of the results.
Model 1 revealed that the rate of identified treatment-related changes increased by 52% when adding [F]FET PET to MRI, resulting in costs of €3,314.51 for each additional correctly identified lesion with treatment-related changes by [F]FET PET that MRI would have misclassified. Model 2 revealed that [F]FET PET correctly identified treatment-related changes in 90% of lesions when routine MRI findings were suspicious for tumor relapse, resulting in costs of €1,740.37 for each lesion.
Integrating [F]FET PET in the follow-up of in children and adolescents with brain and spinal tumor may help improving patient care at acceptable costs.
使用放射性标记氨基酸O-(2-[F]-氟乙基)-L-酪氨酸（[F]FET）的正电子发射断层扫描（PET）在儿童和青少年中枢神经系统肿瘤的随访评估中具有重要临床价值。由于医疗程序必须在社会经济层面上具有合理性，我们确定了[F]FET PET用于识别治疗相关变化的成本效益。
我们分析了两项不同研究的临床数据，这两项研究评估了FET PET在区分儿童和青少年脑与脊髓肿瘤复发及治疗相关变化方面的价值。成本计算基于德国法定医疗保险系统的视角。由于研究的诊断方法存在细微差异，考虑了两种独立的临床场景，包括80例患者的105个病灶：决策树模型1确定了与单独使用磁共振成像（MRI）相比，同时使用[F]FET PET和MRI来识别治疗相关变化的成本效益。决策树模型2确定了在常规MRI结果可疑为肿瘤复发时，单独使用[F]FET PET来识别治疗相关变化的成本效益。确定性和概率性敏感性分析检验了结果的稳健性。
模型1显示，在MRI基础上增加[F]FET PET时，识别出的治疗相关变化率提高了52%，对于每个通过[F]FET PET正确识别出但MRI会误分类的治疗相关变化病灶，额外成本为3314.51欧元。模型2显示，当常规MRI结果可疑为肿瘤复发时，[F]FET PET在90%的病灶中正确识别出治疗相关变化，每个病灶的成本为1740.37欧元。
将[F]FET PET纳入儿童和青少年脑与脊髓肿瘤的随访中，可能有助于以可接受的成本改善患者护理。
