Cost-effectiveness of the implementation of [Ga-68]Ga-PSMA-11 PET/CT at initial prostate cancer staging

Esmee C. A. van der Sar, Willem R. Keusters, Ludwike W. M. van Kalmthout, Arthur J. A. T. Braat, Bart de Keizer, Geert W. J. Frederix, Anko Kooistra, Jules Lavalaye, Marnix G. E. H. Lam, Harm H. E. van Melick

Research output: Contribution to journalArticleAcademicpeer-review

6 Downloads (Pure)

Abstract

Background: Despite its high specificity, PSMA PET/CT has a moderate to low sensitivity of 40–50% for pelvic lymph node detection, implicating that a negative PSMA PET/CT cannot rule out lymph node metastases. This study investigates a strategy of implementing PSMA PET/CT for initial prostate cancer staging and treatment planning compared to conventional diagnostics. In this PSMA PET/CT strategy, a bilateral extended pelvic lymph node dissection (ePLND) is only performed in case of a negative PSMA PET/CT; in case of a positive scan treatment planning is solely based on PSMA PET/CT results. Method: A decision table and lifetime state transition model were created. Quality-adjusted life years and health care costs were modelled over lifetime. Results: The PSMA PET/CT strategy of treatment planning based on initial staging with [ 68Ga]Ga-PSMA-11 PET/CT results in cost-savings of €674 and a small loss in quality of life (QoL), 0.011 QALY per patient. The positive effect of [ 68Ga]Ga-PSMA-11 PET/CT was caused by abandoning both an ePLND and unnecessary treatment in iM1 patients, saving costs and resulting in higher QoL. The negative effect was caused by lower QoL and high costs in the false palliative state, due to pN1 lim patients (≤ 4 pelvic lymph node metastases) being falsely diagnosed as iN1 ext (> 4 pelvic lymph node metastases). These patients received subsequently palliative treatment instead of potentially curative therapy. Conclusion: Initial staging and treatment planning based on [ 68Ga]Ga-PSMA-11 PET/CT saves cost but results in small QALY loss due to the rate of false positive findings.

Original languageEnglish
Article number132
Pages (from-to)1-10
JournalInsights into Imaging
Volume13
Issue number1
DOIs
Publication statusPublished - 13 Aug 2022

Keywords

  • CT
  • Cost-effectiveness
  • Gallium
  • PSMA PET
  • Prostate cancer
  • Radioligand
  • PSMA PET/CT

Fingerprint

Dive into the research topics of 'Cost-effectiveness of the implementation of [Ga-68]Ga-PSMA-11 PET/CT at initial prostate cancer staging'. Together they form a unique fingerprint.

Cite this