Comparison of 18F-sodium fluoride PET/CT, 18F-fluorocholine PET/CT and diffusion-weighted MRI for the detection of bone metastases in recurrent prostate cancer: a cost-effectiveness analysis in France

Mathieu Gauthé, Kevin Zarca, Cyrielle Aveline, Frédéric Lecouvet, Sona Balogova, Olivier Cussenot, Jean-Noël Talbot, Isabelle Durand-Zaleski, Mathieu Gauthé, Kevin Zarca, Cyrielle Aveline, Frédéric Lecouvet, Sona Balogova, Olivier Cussenot, Jean-Noël Talbot, Isabelle Durand-Zaleski

Abstract

Background: The diagnostic performance of 18F-sodium fluoride positron emission tomography/computed tomography (PET/CT) (NaF), 18F-fluorocholine PET/CT (FCH) and diffusion-weighted whole-body magnetic resonance imaging (DW-MRI) in detecting bone metastases in prostate cancer (PCa) patients with first biochemical recurrence (BCR) has already been published, but their cost-effectiveness in this indication have never been compared.

Methods: We performed trial-based and model-based economic evaluations. In the trial, PCa patients with first BCR after previous definitive treatment were prospectively included. Imaging readings were performed both on-site by local specialists and centrally by experts. The economic evaluation extrapolated the diagnostic performances of the imaging techniques using a combination of a decision tree and Markov model based on the natural history of PCa. The health states were non-metastatic and metastatic BCR, non-metastatic and metastatic castration-resistant prostate cancer and death. The state-transition probabilities and utilities associated with each health state were derived from the literature. Real costs were extracted from the National Cost Study of hospital costs and the social health insurance cost schedule.

Results: There was no significant difference in diagnostic performance among the 3 imaging modalities in detecting bone metastases. FCH was the most cost-effective imaging modality above a threshold incremental cost-effectiveness ratio of 3000€/QALY when imaging was interpreted by local specialists and 9000€/QALY when imaging was interpreted by experts.

Conclusions: FCH had a better incremental effect on QALY, independent of imaging reading and should be preferred for detecting bone metastases in patients with biochemical recurrence of prostate cancer.

Trial registration: NCT01501630. Registered 29 December 2011.

Keywords: Bone metastases; Medico-economic; Prostate cancer.

Conflict of interest statement

The authors declare that they have no competing interests.

Figures

Fig. 1
Fig. 1
Decision tree combined with the Markov model used for evaluating costs and health-related outcomes. BCR = patients with first biochemical recurrence of prostate cancer; CRPC: patient with castration-resistant prostate cancer; m0 and m1: patient with and without bone metastases, respectively
Fig. 2
Fig. 2
Incremental cost in Euros and effect of imaging strategies on the cost-effectiveness plane. NaF = 18F-sodium fluoride PET/CT; FCH = 18F-fluorocholine PET/CT; DW-MRI = diffusion-weighted whole-body magnetic resonance imaging
Fig. 3
Fig. 3
Tornado plot presenting uncertainties in costs in Euros within plausible ranges of the 95% confidence intervals. BCR = patients with first biochemical recurrence of prostate cancer; CRPC: patient with castration-resistant prostate cancer; m0 and m1: patient with and without bone metastases, respectively. The vertical line represents the base-case incremental cost-effectiveness ratio (ICER). QALY: quality-adjusted life year
Fig. 4
Fig. 4
Scatter plot showing the uncertainty of the incremental cost-effectiveness ratio in Euros for each imaging modality. ICER = incremental cost-effectiveness ratio; NaF = 18F-sodium fluoride PET/CT; FCH = 18F-fluorocholine PET/CT; DW-MRI = diffusion-weighted whole-body magnetic resonance imaging
Fig. 5
Fig. 5
Cost-effectiveness acceptability curves in Euros showing the results of probabilistic sensitivity analyses for each imaging modality. NaF = 18F-sodium fluoride PET/CT; FCH = 18F-fluorocholine PET/CT; DW-MRI = diffusion-weighted whole-body magnetic resonance imaging

References

    1. Ferlay J, Soerjomataram I, Dikshit R, Eser S, Mathers C, Rebelo M, et al. Cancer incidence and mortality worldwide: sources, methods and major patterns in GLOBOCAN 2012. Int J Cancer. 2015;136:E359–E386. doi: 10.1002/ijc.29210.
    1. James ND, Spears MR, Clarke NW, Dearnaley DP, De Bono JS, Gale J, et al. Survival with newly diagnosed metastatic prostate cancer in the “docetaxel era”: data from 917 patients in the control arm of the STAMPEDE trial (MRC PR08, CRUK/06/019) Eur Urol. 2015;67:1028–1038. doi: 10.1016/j.eururo.2014.09.032.
    1. Nørgaard M, Jensen AØ, Jacobsen JB, Cetin K, Fryzek JP, Sørensen HT. Skeletal related events, bone metastasis and survival of prostate cancer: a population based cohort study in Denmark (1999 to 2007) J Urol. 2010;184:162–167. doi: 10.1016/j.juro.2010.03.034.
    1. Singh D, Yi WS, Brasacchio RA, Muhs AG, Smudzin T, Williams JP, et al. Is there a favorable subset of patients with prostate cancer who develop oligometastases? Int J Radiat Oncol. 2004;58:3–10. doi: 10.1016/S0360-3016(03)01442-1.
    1. Sweeney CJ, Chen Y-H, Carducci M, Liu G, Jarrard DF, Eisenberger M, et al. Chemohormonal therapy in metastatic hormone-sensitive prostate cancer. N Engl J Med. 2015;373:737–746. doi: 10.1056/NEJMoa1503747.
    1. Gauthé M, Aveline C, Lecouvet F, Michaud L, Rousseau C, Tassart M, et al. Impact of sodium 18F-fluoride PET/CT, 18F-fluorocholine PET/CT and whole-body diffusion-weighted MRI on the management of patients with prostate cancer suspicious for metastasis: a prospective multicentre study. World J Urol. 2018. 10.1007/s00345-018-2547-5.
    1. Zacho HD, Nielsen JB, Afshar-Oromieh A, Haberkorn U, de Souza N, De Paepe K, et al. Prospective comparison of 68Ga-PSMA PET/CT, 18F-sodium fluoride PET/CT and diffusion weighted-MRI at for the detection of bone metastases in biochemically recurrent prostate cancer. Eur J Nucl Med Mol Imaging. 2018;45:1884–1897. doi: 10.1007/s00259-018-4058-4.
    1. Gillebert Q, Huchet V, Rousseau C, Cochet A, Olivier P, Courbon F, et al. 18F-fluorocholine PET/CT in patients with occult biochemical recurrence of prostate cancer: detection rate, impact on management and adequacy of impact. A prospective multicentre study. PLOS ONE. 2018;13:e0191487. doi: 10.1371/journal.pone.0191487.
    1. Langsteger W, Balogova S, Huchet V, Beheshti M, Paycha F, Egrot C, et al. Fluorocholine (18F) and sodium fluoride (18F) PET/CT in the detection of prostate cancer: prospective comparison of diagnostic performance determined by masked reading. Q J Nucl Med Mol Imaging. 2011;55:448–457.
    1. Cornford P, Bellmunt J, Bolla M, Briers E, Santis MD, Gross T, et al. EAU-ESTRO-SIOG guidelines on prostate cancer. Part II: treatment of relapsing, metastatic, and castration-resistant prostate cancer. Eur Urol. 2017;71:630–642. doi: 10.1016/j.eururo.2016.08.002.
    1. Professionals S-O. EAU Guidelines: Oncology Guidelines. Uroweb . Accessed 11 Dec 2019.
    1. Recommandations de l’A.F.U. classées par année | Urofrance. . Accessed 11 Dec 2019.
    1. Beheshti M, Vali R, Waldenberger P, Fitz F, Nader M, Loidl W, et al. Detection of bone metastases in patients with prostate cancer by 18F fluorocholine and 18F fluoride PET–CT: a comparative study. Eur J Nucl Med Mol Imaging. 2008;35:1766–1774. doi: 10.1007/s00259-008-0788-z.
    1. Vande Berg BC, Malghem J, Lecouvet FE, Maldague B. Classification and detection of bone marrow lesions with magnetic resonance imaging. Skelet Radiol. 1998;27:529–545. doi: 10.1007/s002560050434.
    1. Vanel D, Dromain C, Tardivon A. MRI of bone marrow disorders. Eur Radiol. 2000;10:224–229. doi: 10.1007/s003300050038.
    1. Sonnenberg FA, Beck JR. Markov models in medical decision making: a practical guide. Med Decis Mak. 1993;13:322–338. doi: 10.1177/0272989X9301300409.
    1. Hernandez RK, Wade SW, Reich A, Pirolli M, Liede A, Lyman GH. Incidence of bone metastases in patients with solid tumors: analysis of oncology electronic medical records in the United States. BMC Cancer. 2018;18:44. doi: 10.1186/s12885-017-3922-0.
    1. Hirst CJ, Cabrera C, Kirby M. Epidemiology of castration resistant prostate cancer: a longitudinal analysis using a UK primary care database. Cancer Epidemiol. 2012;36:e349–e353. doi: 10.1016/j.canep.2012.07.012.
    1. Institut national de la statistique et des études économiques. Espérance de vie - Mortalité − Tableaux de l’économie française. . Accessed 14 May 2019.
    1. Smith MR, Kabbinavar F, Saad F, Hussain A, Gittelman MC, Bilhartz DL, et al. Natural history of rising serum prostate-specific antigen in men with castrate nonmetastatic prostate Cancer. J Clin Oncol. 2005;23:2918–2925. doi: 10.1200/JCO.2005.01.529.
    1. Fizazi K, Carducci M, Smith M, Damião R, Brown J, Karsh L, et al. Denosumab versus zoledronic acid for treatment of bone metastases in men with castration-resistant prostate cancer: a randomised, double-blind study. Lancet. 2011;377:813–822. doi: 10.1016/S0140-6736(10)62344-6.
    1. Torvinen S, Färkkilä N, Sintonen H, Saarto T, Roine RP, Taari K. Health-related quality of life in prostate cancer. Acta Oncol. 2013;52:1094–1101. doi: 10.3109/0284186X.2012.760848.
    1. Saad F, Cella D, Basch E, Hadaschik BA, Mainwaring PN, Oudard S, et al. Effect of apalutamide on health-related quality of life in patients with non-metastatic castration-resistant prostate cancer: an analysis of the SPARTAN randomised, placebo-controlled, phase 3 trial. Lancet Oncol. 2018;19:1404–1416. doi: 10.1016/S1470-2045(18)30456-X.
    1. Lloyd AJ, Kerr C, Penton J, Knerer G. Health-related quality of life and health Utilities in Metastatic Castrate-Resistant Prostate Cancer: a survey capturing experiences from a diverse sample of UK patients. Value Health. 2015;18:1152–1157. doi: 10.1016/j.jval.2015.08.012.
    1. Agence technique de l’information sur l’hospitalisation. Référentiel national de coûts des prises en charge (ENC). . Accessed 13 Feb 2019.
    1. L’Assurance Maladie. Base des Médicaments et Informations Tarifaires. . Accessed 13 Feb 2019.
    1. Haute Autorité de Santé. Choix méthodologiques pour l’évaluation économique à la HAS. . Accessed 21 Feb 2019.
    1. Filipović-Pierucci A, Zarca K, Durand-Zaleski I. Markov Models for Health Economic Evaluations: The R Package heemod. ArXiv170203252 Stat. 2017. . Accessed 26 Mar 2019.
    1. Husereau D, Drummond M, Petrou S, Carswell C, Moher D, Greenberg D, et al. Consolidated health economic evaluation reporting standards (CHEERS)—explanation and elaboration: a report of the ISPOR health economic evaluation publication guidelines good reporting practices task force. Value Health. 2013;16:231–250. doi: 10.1016/j.jval.2013.02.002.
    1. Shen G, Deng H, Hu S, Jia Z. Comparison of choline-PET/CT, MRI, SPECT, and bone scintigraphy in the diagnosis of bone metastases in patients with prostate cancer: a meta-analysis. Skelet Radiol. 2014;43:1503–1513. doi: 10.1007/s00256-014-1903-9.
    1. Barchetti F, Stagnitti A, Megna V, Al Ansari N, Marini A, Musio D, et al. Unenhanced whole-body MRI versus PET-CT for the detection of prostate cancer metastases after primary treatment. Eur Rev Med Pharmacol Sci. 2016;20:3770–3776.
    1. Padhani AR, Lecouvet FE, Tunariu N, Koh D-M, De Keyzer F, Collins DJ, et al. METastasis reporting and data system for prostate Cancer: practical guidelines for acquisition, interpretation, and reporting of whole-body magnetic resonance imaging-based evaluations of multiorgan involvement in advanced prostate Cancer. Eur Urol. 2017;71:81–92. doi: 10.1016/j.eururo.2016.05.033.

Source: PubMed

Patrocinadores y Colaboradores

Condiciones médicas

Intervenciones de drogas

3
Suscribir