Abstract
The incidence of IPMN is increasing, mainly attributed to the expanded application of radiological cross-sectional imaging and improvements in image quality. IPMN are the cause of approximately 10% of all pancreatectomies in the USA. A significant number of surgically treated IPMNs do not show high-grade dysplasia or invasive cancer, raising the question of overtreatment, and the need for better diagnostic accuracy. F-18-FDG-PET/CT demonstrated promising diagnostic performance in the detection of malignant transformation of IPMN in comparison to CT and MRI. In this study, the authors analyze whether a supplemental F-18-FDG-PET/CT to the current diagnostic pathway of IPMN could be cost-effective. Results suggest that implementation of F-18-FDG-PET/CT in a preoperative setting could be beneficial from a health care system perspective. It also encourages the research community to investigate if F-18-FDG-PET/CT could be a useful addition in other diagnostic settings within IPMN management. Accurate detection of malignant transformation and risk-stratification of intraductal papillary mucinous neoplasms (IPMN) has remained a diagnostic challenge. Preliminary findings have indicated a promising role of positron emission tomography combined with computed tomography and F-18-fluorodeoxyglucose (F-18-FDG-PET/CT) in detecting malignant IPMN. Therefore, the aim of this model-based economic evaluation was to analyze whether supplemental FDG-PET/CT could be cost-effective in patients with IPMN. Decision analysis and Markov modeling were applied to simulate patients' health states across a time frame of 15 years. CT/MRI based imaging was compared to a strategy with supplemental F-18-FDG-PET/CT. Cumulative costs in US-$ and outcomes in quality-adjusted life years (QALY) were computed based on input parameters extracted from recent literature. The stability of the model was evaluated by deterministic sensitivity analyses. In the base-case scenario, the CT/MRI-strategy resulted in cumulative discounted costs of USD $106,424 and 8.37 QALYs, while the strategy with supplemental FDG-PET/CT resulted in costs of USD $104,842 and a cumulative effectiveness of 8.48 QALYs and hence was cost-saving. A minimum specificity of FDG-PET/CT of 71.5% was required for the model to yield superior net monetary benefits compared to CT/MRI. This model-based economic evaluation indicates that supplemental F-18-FDG-PET/CT could have a favorable economic value in the management of IPMN and could be cost-saving in the chosen setting. Prospective studies with standardized protocols for FDG-PET/CT could help to better determine the value of FDG-PET/CT.
| Dokumententyp: | Zeitschriftenartikel |
|---|---|
| Fakultät: | Medizin |
| Themengebiete: | 600 Technik, Medizin, angewandte Wissenschaften > 610 Medizin und Gesundheit |
| Sprache: | Englisch |
| Dokumenten ID: | 97019 |
| Datum der Veröffentlichung auf Open Access LMU: | 05. Jun. 2023, 15:24 |
| Letzte Änderungen: | 17. Okt. 2023, 14:54 |
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