Jurij Rosen, Jan-Michael Werner, Garry S Ceccon, Elena K Rosen, Michael M Wollring, Isabelle Stetter, Philipp Lohmann, Felix M Mottaghy, Lisbeth Marner, Ian Law, Gereon R Fink, Karl-Josef Langen, Norbert Galldiks
{"title":"儿童和青少年脑和脊柱肿瘤治疗相关改变的诊断：使用MRI和[18 F]FET PET进行成本-效果分析。","authors":"Jurij Rosen, Jan-Michael Werner, Garry S Ceccon, Elena K Rosen, Michael M Wollring, Isabelle Stetter, Philipp Lohmann, Felix M Mottaghy, Lisbeth Marner, Ian Law, Gereon R Fink, Karl-Josef Langen, Norbert Galldiks","doi":"10.1007/s00259-025-07377-x","DOIUrl":null,"url":null,"abstract":"<p><strong>Purpose: </strong>PET using the radiolabeled amino acid O-(2-[<sup>18</sup>F]-fluoroethyl)-L-tyrosine ([<sup>18</sup>F]FET) has considerable clinical value for follow-up evaluation of central nervous system tumors in children and adolescents. As medical procedures must be justified socio-economically, we determined cost-effectiveness of [<sup>18</sup>F]FET PET for identification of treatment-related changes.</p><p><strong>Methods: </strong>We analyzed clinical data from two different studies that assessed the value of FET PET to differentiate between brain and spinal tumor relapse and treatment-related changes in children and adolescents. Cost calculation was based on the German statutory health insurance system perspective. Due to subtle differences in the diagnostic approach of the studies, two separate clinical scenarios including 80 patients with 105 lesions were considered: Decision tree model 1 determined cost-effectiveness of simultaneous [<sup>18</sup>F]FET PET and MRI in comparison to MRI alone to identify treatment-related changes. Decision tree model 2 determined cost-effectiveness of [<sup>18</sup>F]FET PET alone to identify treatment-related changes when routine MRI findings were suspicious for tumor relapse. Deterministic and probabilistic sensitivity analyses tested the robustness of the results.</p><p><strong>Results: </strong>Model 1 revealed that the rate of identified treatment-related changes increased by 52% when adding [<sup>18</sup>F]FET PET to MRI, resulting in costs of €3,314.51 for each additional correctly identified lesion with treatment-related changes by [<sup>18</sup>F]FET PET that MRI would have misclassified. Model 2 revealed that [<sup>18</sup>F]FET PET correctly identified treatment-related changes in 90% of lesions when routine MRI findings were suspicious for tumor relapse, resulting in costs of €1,740.37 for each lesion.</p><p><strong>Conclusion: </strong>Integrating [<sup>18</sup>F]FET PET in the follow-up of in children and adolescents with brain and spinal tumor may help improving patient care at acceptable costs.</p>","PeriodicalId":11909,"journal":{"name":"European Journal of Nuclear Medicine and Molecular Imaging","volume":" ","pages":"4616-4626"},"PeriodicalIF":7.6000,"publicationDate":"2025-10-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC12491346/pdf/","citationCount":"0","resultStr":"{\"title\":\"Diagnosis of treatment-related changes in children and adolescents with brain and spinal tumors: a cost-effectiveness analysis using MRI and [18 F]FET PET.\",\"authors\":\"Jurij Rosen, Jan-Michael Werner, Garry S Ceccon, Elena K Rosen, Michael M Wollring, Isabelle Stetter, Philipp Lohmann, Felix M Mottaghy, Lisbeth Marner, Ian Law, Gereon R Fink, Karl-Josef Langen, Norbert Galldiks\",\"doi\":\"10.1007/s00259-025-07377-x\",\"DOIUrl\":null,\"url\":null,\"abstract\":\"<p><strong>Purpose: </strong>PET using the radiolabeled amino acid O-(2-[<sup>18</sup>F]-fluoroethyl)-L-tyrosine ([<sup>18</sup>F]FET) has considerable clinical value for follow-up evaluation of central nervous system tumors in children and adolescents. As medical procedures must be justified socio-economically, we determined cost-effectiveness of [<sup>18</sup>F]FET PET for identification of treatment-related changes.</p><p><strong>Methods: </strong>We analyzed clinical data from two different studies that assessed the value of FET PET to differentiate between brain and spinal tumor relapse and treatment-related changes in children and adolescents. Cost calculation was based on the German statutory health insurance system perspective. Due to subtle differences in the diagnostic approach of the studies, two separate clinical scenarios including 80 patients with 105 lesions were considered: Decision tree model 1 determined cost-effectiveness of simultaneous [<sup>18</sup>F]FET PET and MRI in comparison to MRI alone to identify treatment-related changes. Decision tree model 2 determined cost-effectiveness of [<sup>18</sup>F]FET PET alone to identify treatment-related changes when routine MRI findings were suspicious for tumor relapse. Deterministic and probabilistic sensitivity analyses tested the robustness of the results.</p><p><strong>Results: </strong>Model 1 revealed that the rate of identified treatment-related changes increased by 52% when adding [<sup>18</sup>F]FET PET to MRI, resulting in costs of €3,314.51 for each additional correctly identified lesion with treatment-related changes by [<sup>18</sup>F]FET PET that MRI would have misclassified. Model 2 revealed that [<sup>18</sup>F]FET PET correctly identified treatment-related changes in 90% of lesions when routine MRI findings were suspicious for tumor relapse, resulting in costs of €1,740.37 for each lesion.</p><p><strong>Conclusion: </strong>Integrating [<sup>18</sup>F]FET PET in the follow-up of in children and adolescents with brain and spinal tumor may help improving patient care at acceptable costs.</p>\",\"PeriodicalId\":11909,\"journal\":{\"name\":\"European Journal of Nuclear Medicine and Molecular Imaging\",\"volume\":\" \",\"pages\":\"4616-4626\"},\"PeriodicalIF\":7.6000,\"publicationDate\":\"2025-10-01\",\"publicationTypes\":\"Journal Article\",\"fieldsOfStudy\":null,\"isOpenAccess\":false,\"openAccessPdf\":\"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC12491346/pdf/\",\"citationCount\":\"0\",\"resultStr\":null,\"platform\":\"Semanticscholar\",\"paperid\":null,\"PeriodicalName\":\"European Journal of Nuclear Medicine and Molecular Imaging\",\"FirstCategoryId\":\"3\",\"ListUrlMain\":\"https://doi.org/10.1007/s00259-025-07377-x\",\"RegionNum\":1,\"RegionCategory\":\"医学\",\"ArticlePicture\":[],\"TitleCN\":null,\"AbstractTextCN\":null,\"PMCID\":null,\"EPubDate\":\"2025/6/4 0:00:00\",\"PubModel\":\"Epub\",\"JCR\":\"Q1\",\"JCRName\":\"RADIOLOGY, NUCLEAR MEDICINE & MEDICAL IMAGING\",\"Score\":null,\"Total\":0}","platform":"Semanticscholar","paperid":null,"PeriodicalName":"European Journal of Nuclear Medicine and Molecular Imaging","FirstCategoryId":"3","ListUrlMain":"https://doi.org/10.1007/s00259-025-07377-x","RegionNum":1,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":null,"EPubDate":"2025/6/4 0:00:00","PubModel":"Epub","JCR":"Q1","JCRName":"RADIOLOGY, NUCLEAR MEDICINE & MEDICAL IMAGING","Score":null,"Total":0}
Diagnosis of treatment-related changes in children and adolescents with brain and spinal tumors: a cost-effectiveness analysis using MRI and [18 F]FET PET.
Purpose: PET using the radiolabeled amino acid O-(2-[18F]-fluoroethyl)-L-tyrosine ([18F]FET) has considerable clinical value for follow-up evaluation of central nervous system tumors in children and adolescents. As medical procedures must be justified socio-economically, we determined cost-effectiveness of [18F]FET PET for identification of treatment-related changes.
Methods: We analyzed clinical data from two different studies that assessed the value of FET PET to differentiate between brain and spinal tumor relapse and treatment-related changes in children and adolescents. Cost calculation was based on the German statutory health insurance system perspective. Due to subtle differences in the diagnostic approach of the studies, two separate clinical scenarios including 80 patients with 105 lesions were considered: Decision tree model 1 determined cost-effectiveness of simultaneous [18F]FET PET and MRI in comparison to MRI alone to identify treatment-related changes. Decision tree model 2 determined cost-effectiveness of [18F]FET PET alone to identify treatment-related changes when routine MRI findings were suspicious for tumor relapse. Deterministic and probabilistic sensitivity analyses tested the robustness of the results.
Results: Model 1 revealed that the rate of identified treatment-related changes increased by 52% when adding [18F]FET PET to MRI, resulting in costs of €3,314.51 for each additional correctly identified lesion with treatment-related changes by [18F]FET PET that MRI would have misclassified. Model 2 revealed that [18F]FET PET correctly identified treatment-related changes in 90% of lesions when routine MRI findings were suspicious for tumor relapse, resulting in costs of €1,740.37 for each lesion.
Conclusion: Integrating [18F]FET PET in the follow-up of in children and adolescents with brain and spinal tumor may help improving patient care at acceptable costs.
期刊介绍：
The European Journal of Nuclear Medicine and Molecular Imaging serves as a platform for the exchange of clinical and scientific information within nuclear medicine and related professions. It welcomes international submissions from professionals involved in the functional, metabolic, and molecular investigation of diseases. The journal's coverage spans physics, dosimetry, radiation biology, radiochemistry, and pharmacy, providing high-quality peer review by experts in the field. Known for highly cited and downloaded articles, it ensures global visibility for research work and is part of the EJNMMI journal family.
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