Cost-Effectiveness Analysis of<sup>68</sup>Ga-DOTATATE PET/MRI in Radiotherapy Planning in Patients with Intermediate-Risk Meningioma
José A. Rodriguez, Gabriela Martinez, Sean S. Mahase, Michelle Roytman, Arsalan Haghdel, Sean Kim, Gabriela Madera, Rajiv Magge, Peter Pan, Rohan Ramakrishna, Theodore H. Schwartz, Susan C. Pannullo, Joseph R. Osborne, Eaton Lin, Jonathan Knisely, Pina C. Sanelli, Jana Ivanidze
Abstract
<h3>BACKGROUND AND PURPOSE:</h3> While contrast-enhanced MR imaging is the criterion standard in meningioma diagnosis and treatment response assessment, gallium <sup>68</sup>Ga-DOTATATE PET/MR imaging has increasingly demonstrated utility in meningioma diagnosis and management. Integrating <sup>68</sup>Ga-DOTATATE PET/MR imaging in postsurgical radiation planning reduces the planning target volume and organ-at-risk dose. However, <sup>68</sup>Ga-DOTATATE PET/MR imaging is not widely implemented in clinical practice due to higher perceived costs. Our study analyzes the cost-effectiveness of <sup>68</sup>Ga-DOTATATE PET/MR imaging for postresection radiation therapy planning in patients with intermediate-risk meningioma. <h3>MATERIALS AND METHODS:</h3> We developed a decision-analytical model based on both recommended guidelines on meningioma management and our institutional experience. Markov models were implemented to estimate quality-adjusted life-years (QALY). Cost-effectiveness analyses with willingness-to-pay thresholds of $50,000/QALY and $100,000/QALY were performed from a societal perspective. Sensitivity analyses were conducted to validate the results. Model input values were based on published literature. <h3>RESULTS:</h3> The cost-effectiveness results demonstrated that <sup>68</sup>Ga-DOTATATE PET/MR imaging yields higher QALY (5.47 versus 5.05) at a higher cost ($404,260 versus $395,535) compared with MR imaging alone. The incremental cost-effectiveness ratio analysis determined that <sup>68</sup>Ga-DOTATATE PET/MR imaging is cost-effective at a willingness to pay of $50,000/QALY and $100,000/QALY. Furthermore, sensitivity analyses showed that <sup>68</sup>Ga-DOTATATE PET/MR imaging is cost-effective at $50,000/QALY ($100,000/QALY) for specificity and sensitivity values above 76% (58%) and 53% (44%), respectively. <h3>CONCLUSIONS:</h3> <sup>68</sup>Ga-DOTATATE PET/MR imaging as an adjunct imaging technique is cost-effective in postoperative treatment planning in patients with meningiomas. Most important, the model results show that the sensitivity and specificity cost-effective thresholds of <sup>68</sup>Ga-DOTATATE PET/MR imaging could be attained in clinical practice.