Cost-effectiveness of [18F]FDG PET/CT in follow-up after thermal ablation in patients with colorectal liver metastases in the Dutch healthcare setting
S. van Mossel (University of Twente, Leiden University Medical Center)
O. D. Bijlstra (Leiden University Medical Center, Amsterdam UMC)
F. A. van Delft (University of Twente)
M. C. Burgmans (Leiden University Medical Center)
P. Hendriks (Leiden University Medical Center)
J. S.D. Mieog (Leiden University Medical Center)
D. D.D. Rietbergen (Leiden University Medical Center)
R. J. Swijnenburg (Amsterdam UMC)
L. F. de Geus-Oei (Leiden University Medical Center, University of Twente, TU Delft - RST/Radiation, Science and Technology)
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Abstract
Introduction: The ESMO and ECIO-ESOI consensus guidelines vary in their recommendations regarding the use of 18F-Fluorodeoxyglucose ([18F]FDG) PET/CT in the follow-up after thermal ablation in patients with colorectal liver metastases. This is partly because studies providing data on long-term benefits of [18F]FDG PET/CT are lacking. Therefore, a simulation model was developed to examine how follow-up with [18F]FDG PET/CT impacts treatment planning, health and cost outcomes. Methods: For an illustrative Dutch cohort, lifetime health and cost outcomes were simulated to assess the cost-effectiveness of performing a single additional [18F]FDG PET/CT. Patients followed a standard surveillance schedule consisting of three-monthly serum CEA and contrast-enhanced CT, plus [18F]FDG PET/CT 3–4 months after thermal ablation. Therapy could be repeated downstream the care pathway. Quality-of-life and survival estimates were based on disease stage and age. Costs were determined from a healthcare perspective incorporating costs related to diagnostics and treatments. The Consolidated Health Economic Evaluation Reporting Standards were followed. Results: Health benefits of additional [18F]FDG PET/CT were negligible, incremental QALYs < 0.001, whereas costs increased by €1,277, mainly due to the additional imaging. This lack of health benefits can be explained by the small subset of simulated patients (<5 %) in whom [18F]FDG PET/CT affected treatment planning. Discussion: Additional [18F]FDG PET/CT 3–4 months after thermal ablation is unlikely to be cost-effective. More research is needed to determine if using [18F]FDG PET/CT in subgroups of patients, or at alternative time points, is cost-effective. This requires collecting more (extensive) follow-up data across multiple centres to reflect heterogeneity between hospitals’ clinical practices.
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