Cost-effectiveness of one-stop-shop [18F]Fluorocholine PET/CT to localise parathyroid adenomas in patients suffering from primary hyperparathyroidism

Title

Cost-effectiveness of one-stop-shop [18F]Fluorocholine PET/CT to localise parathyroid adenomas in patients suffering from primary hyperparathyroidism

 Author

van Mossel, Sietse (Leiden University Medical Center; University of Twente)
Saing, Sopany (University of Twente)
Appelman-Dijkstra, Natasha (Leiden University Medical Center)
Quak, Elske (Centre François Baclesse)
Schepers, Abbey (Leiden University Medical Center)
Smit, Frits (Leiden University Medical Center; Alrijne Medical Centre)
de Geus-Oei, L.F. (TU Delft RST/Radiation, Science and Technology; Leiden University Medical Center; University of Twente)
Vriens, Dennis (Leiden University Medical Center; Radboud University Medical Center)

Department

RST/Radiation, Science and Technology

 Date

2024

 Abstract

Purpose: We conducted a cost-effectiveness analysis in which we compared a preoperative [18F]Fluorocholine PET/CT-based one-stop-shop imaging strategy with current best practice in which [18F]Fluorocholine PET/CT is only recommended after negative or inconclusive [99mTc]Tc-methoxy isobutyl isonitrile SPECT/CT for patients suffering from primary hyperparathyroidism. We investigated whether the one-stop-shop strategy performs as well as current best practice but at lower costs. Methods: We developed a cohort-level state transition model to evaluate both imaging strategies respecting an intraoperative parathyroid hormone monitored treatment setting as well as a traditional treatment setting. The model reflects patients’ hospital journeys after biochemically diagnosed primary hyperparathyroidism. A cycle length of twelve months and a lifetime horizon were used. We conducted probabilistic analyses simulating 50,000 cohorts to assess joint parameter uncertainty. The incremental net monetary benefit and cost for each quality-adjusted life year were estimated. Furthermore, threshold analyses regarding the tariff of [18F]Fluorocholine PET/CT and the sensitivity of [99mTc]Tc-methoxy isobutyl isonitrile SPECT/CT were performed. Results: The simulated long-term health effects and costs were similar for both imaging strategies. Accordingly, there was no incremental net monetary benefit and the one-stop-shop strategy did not result in lower costs. These results applied to both treatment settings. The threshold analysis indicated that a tariff of €885 for [18F]Fluorocholine PET/CT was required to be cost-effective compared to current best practice. Conclusion: Both preoperative imaging strategies can be used interchangeably. Daily clinical practice grounds such as available local resources and patient preferences should inform policy-making on whether a hospital should implement the one-stop-shop imaging strategy.


 Subject

Cost-effectiveness
Fluorocholine
Hyperparathyroidism
Parathyroid
PET/CT
Sestamibi

 To reference this document use:

http://resolver.tudelft.nl/uuid:c4be3919-1e34-4d94-8485-d3827f26e667

 DOI

https://doi.org/10.1007/s00259-024-06771-1

 ISSN

1619-7070

 Source

European Journal of Nuclear Medicine and Molecular Imaging

 Part of collection

Institutional Repository

 Document type

journal article

 Rights

© 2024 Sietse van Mossel, Sopany Saing, Natasha Appelman-Dijkstra, Elske Quak, Abbey Schepers, Frits Smit, L.F. de Geus-Oei, Dennis Vriens
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