PT  - JOURNAL ARTICLE
AU  - Rodriguez, J.
AU  - Martinez, G.
AU  - Mahase, S.
AU  - Roytman, M.
AU  - Haghdel, A.
AU  - Kim, S.
AU  - Madera, G.
AU  - Magge, R.
AU  - Pan, P.
AU  - Ramakrishna, R.
AU  - Schwartz, T.H.
AU  - Pannullo, S.C.
AU  - Osborne, J.R.
AU  - Lin, E.
AU  - Knisely, J.P.S.
AU  - Sanelli, P.C.
AU  - Ivanidze, J.
TI  - Cost-Effectiveness Analysis of <sup>68</sup>Ga-DOTATATE PET/MRI in Radiotherapy Planning in Patients with Intermediate-Risk Meningioma
AID  - 10.3174/ajnr.A7901
DP  - 2023 Jun 08
TA  - American Journal of Neuroradiology
4099  - http://www.ajnr.org/content/early/2023/06/08/ajnr.A7901.short
4100  - http://www.ajnr.org/content/early/2023/06/08/ajnr.A7901.full
AB  - BACKGROUND AND PURPOSE: While contrast-enhanced MR imaging is the criterion standard in meningioma diagnosis and treatment response assessment, gallium 68Ga-DOTATATE PET/MR imaging has increasingly demonstrated utility in meningioma diagnosis and management. Integrating 68Ga-DOTATATE PET/MR imaging in postsurgical radiation planning reduces the planning target volume and organ-at-risk dose. However, 68Ga-DOTATATE PET/MR imaging is not widely implemented in clinical practice due to higher perceived costs. Our study analyzes the cost-effectiveness of 68Ga-DOTATATE PET/MR imaging for postresection radiation therapy planning in patients with intermediate-risk meningioma.MATERIALS AND METHODS: 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.RESULTS: The cost-effectiveness results demonstrated that 68Ga-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 68Ga-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 68Ga-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.CONCLUSIONS: 68Ga-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 68Ga-DOTATATE PET/MR imaging could be attained in clinical practice.CTCAECommon Terminology Criteria for Adverse EventsEBRTexternal beam radiotherapyGTRgross total resectionPFSprogression-free survivalQALYquality-adjusted life-yearsRTradiotherapySRSstereotactic radiosurgerySSTR2Asomatostatin receptor 2AWHOWorld Health OrganizationWTPwillingness to pay