Comparison of CT, MRI, and F-18 FDG PET/CT for initial N-staging of oral squamous cell carcinoma: a cost-effectiveness analysis
Burian E, Palla B, Callahan N, Pyka T, Wolff C, Von Schacky CE, Schmid A, Froelich MF, Rubenthaler J, Makowski MR, Gassert FG (2022)
Publication Type: Journal article
Publication year: 2022
Journal
Book Volume: 49
Pages Range: 3870-3877
Journal Issue: 11
DOI: 10.1007/s00259-022-05843-4
Abstract
Background and purpose: Treatment of oral squamous cell carcinoma (OSCC) is based on clinical exam, biopsy, and a precise imaging-based TNM-evaluation. A high sensitivity and specificity for magnetic resonance imaging (MRI) and F-18 FDG PET/CT are reported for N-staging. Nevertheless, staging of oral squamous cell carcinoma is most often based on computed tomography (CT) scans. This study aims to evaluate cost-effectiveness of MRI and PET/CT compared to standard of care imaging in initial staging of OSCC within the US Healthcare System. Methods: A decision model was constructed using quality-adjusted life years (QALYs) and overall costs of different imaging strategies including a CT of the head, neck, and the thorax, MRI of the neck with CT of the thorax, and whole body F-18 FDG PET/CT using Markov transition simulations for different disease states. Input parameters were derived from literature and willingness to pay (WTP) was set to US $100,000/QALY. Deterministic sensitivity analysis of diagnostic parameters and costs was performed. Monte Carlo modeling was used for probabilistic sensitivity analysis. Results: In the base-case scenario, total costs were at US $239,628 for CT, US $240,001 for MRI, and US $239,131 for F-18 FDG PET/CT whereas the model yielded an effectiveness of 5.29 QALYs for CT, 5.30 QALYs for MRI, and 5.32 QALYs for F-18 FDG PET/CT respectively. F-18 FDG PET/CT was the most cost-effective strategy over MRI as well as CT, and MRI was the cost-effective strategy over CT. Deterministic and probabilistic sensitivity analysis showed high robustness of the model with incremental cost effectiveness ratio remaining below US $100,000/QALY for a wide range of variability of input parameters. Conclusion: F-18 FDG PET/CT is the most cost-effective strategy in the initial N-staging of OSCC when compared to MRI and CT. Despite less routine use, both whole body PET/CT and MRI are cost-effective modalities in the N-staging of OSCC. Based on these findings, the implementation of PET/CT for initial staging could be suggested to help reduce costs while increasing effectiveness in OSCC.
Involved external institutions
Technische Universität München (TUM)
Germany (DE)
Universitätsklinikum Mannheim
Germany (DE)
Ludwig-Maximilians-Universität (LMU)
Germany (DE)
University of Illinois at Urbana-Champaign
United States (USA) (US)
Universität Bern
Switzerland (CH)
Germany (DE)
Universitätsklinikum Mannheim
Germany (DE)
Ludwig-Maximilians-Universität (LMU)
Germany (DE)
University of Illinois at Urbana-Champaign
United States (USA) (US)
Universität Bern
Switzerland (CH)
How to cite
APA:
Burian, E., Palla, B., Callahan, N., Pyka, T., Wolff, C., Von Schacky, C.E.,... Gassert, F.G. (2022). Comparison of CT, MRI, and F-18 FDG PET/CT for initial N-staging of oral squamous cell carcinoma: a cost-effectiveness analysis. European Journal of Nuclear Medicine and Molecular Imaging, 49(11), 3870-3877. https://doi.org/10.1007/s00259-022-05843-4
MLA:
Burian, Egon, et al. "Comparison of CT, MRI, and F-18 FDG PET/CT for initial N-staging of oral squamous cell carcinoma: a cost-effectiveness analysis." European Journal of Nuclear Medicine and Molecular Imaging 49.11 (2022): 3870-3877.
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