Cost-effectiveness of one-stop-shop [18F]Fluorocholine PET/CT to localise parathyroid adenomas in patients suffering from primary hyperparathyroidism
Sietse van Mossel, Sopany Saing, Natasha M. Appelman‐Dijkstra, Elske Quak, Abbey Schepers, Frits Smit, Lioe‐Fee de Geus‐Oei, Dennis Vriens
Abstract
Abstract Purpose We conducted a cost-effectiveness analysis in which we compared a preoperative [ 18 F]Fluorocholine PET/CT-based one-stop-shop imaging strategy with current best practice in which [ 18 F]Fluorocholine PET/CT is only recommended after negative or inconclusive [ 99m Tc]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 [ 18 F]Fluorocholine PET/CT and the sensitivity of [ 99m Tc]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 [ 18 F]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.