TY - JOUR
T1 - Cost-effectiveness of the implementation of [Ga-68]Ga-PSMA-11 PET/CT at initial prostate cancer staging
AU - van der Sar, Esmee C. A.
AU - Keusters, Willem R.
AU - van Kalmthout, Ludwike W. M.
AU - Braat, Arthur J. A. T.
AU - de Keizer, Bart
AU - Frederix, Geert W. J.
AU - Kooistra, Anko
AU - Lavalaye, Jules
AU - Lam, Marnix G. E. H.
AU - van Melick, Harm H. E.
N1 - Funding Information:
The authors want to thank the Koningin Wilhelmina Fonds (Dutch cancer society) (KWF) for their funding and the registration team of the Netherlands Comprehensive Cancer Organisation (IKNL) for the collection of data for the Netherlands Cancer Registry.
Funding Information:
This study was funded by Koningin Wilhelmina Fonds (Dutch cancer society). They had no role in the design of the study and collection, analysis and interpretation of data and in writing the manuscript.
Publisher Copyright:
© 2022, The Author(s).
PY - 2022/8/13
Y1 - 2022/8/13
N2 - 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.
AB - 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.
KW - CT
KW - Cost-effectiveness
KW - Gallium
KW - PSMA PET
KW - Prostate cancer
KW - Radioligand
KW - PSMA PET/CT
UR - http://www.scopus.com/inward/record.url?scp=85135898397&partnerID=8YFLogxK
U2 - 10.1186/s13244-022-01265-w
DO - 10.1186/s13244-022-01265-w
M3 - Article
C2 - 35962838
SN - 1869-4101
VL - 13
SP - 1
EP - 10
JO - Insights into Imaging
JF - Insights into Imaging
IS - 1
M1 - 132
ER -