A cost-utility analysis of 18F-fluorocholine-positron emission tomography imaging for localizing primary hyperparathyroidism in the United States.

Abstract

BACKGROUND:

Primary hyperparathyroidism historically necessitated bilateral neck exploration to remove abnormal parathyroid tissue. Improved localization allows for focused parathyroidectomy with lower complication risks. Recently, positron emission tomography using radiolabeled 18F-fluorocholine demonstrated high accuracy in detecting these lesions, but its cost-effectiveness has not been studied in the United States.

METHODS:

A decision tree modeled patients who underwent parathyroidectomy for primary hyperparathyroidism using single preoperative localization modalities: (1) positron emission tomography using radiolabeled 18F-fluorocholine, (2) 4-dimensional computed tomography, (3) ultrasound, and (4) sestamibi single photon emission computed tomography (SPECT). All patients underwent either focused parathyroidectomy versus bilateral neck exploration, with associated cost ($) and clinical outcomes measured in quality-adjusted life-years gained. Model parameters were informed by literature review and Medicare costs. Incremental cost-utility ratios were calculated in US dollars/quality-adjusted life-years gained, with a willingness-to-pay threshold set at $100,000/quality-adjusted life-year. One-way, 2-way, and threshold sensitivity analyses were performed.

RESULTS:

Positron emission tomography using radiolabeled 18F-fluorocholine gained the most quality-adjusted life-years (23.9) and was the costliest ($2,096), with a total treatment cost of $11,245 or $470/quality-adjusted life-year gained. Sestamibi single photon emission computed tomography and ultrasound were dominated strategies. Compared with 4-dimentional computed tomography, the incremental cost-utility ratio for positron emission tomography using radiolabeled 18F-fluorocholine was $91,066/quality-adjusted life-year gained in our base case analysis, which was below the willingness-to-pay threshold. In 1-way sensitivity analysis, the incremental cost-utility ratio was sensitive to test accuracy, positron emission tomography using radiolabeled 18F-fluorocholine price, postoperative complication probabilities, proportion of bilateral neck exploration patients needing overnight hospitalization, and life expectancy.

CONCLUSION:

Our model elucidates scenarios in which positron emission tomography using radiolabeled 18F-fluorocholine can potentially be a cost-effective imaging option for primary hyperparathyroidism in the United States. Further investigation is needed to determine the maximal cost-effectiveness for positron emission tomography using radiolabeled 18F-fluorocholine in selected populations.

• Authors: Ava Yap, Thomas A Hope, Claire E Graves, Wouter Kluijfhout, Wen T Shen, Jessica E Gosnell, Julie A Sosa, Sanziana A Roman, Quan-Yang Duh, Insoo Suh
• Journal: Surgery (Surgery) Vol. 171 Issue 1 Pg. 55-62 (01 2022) ISSN: 1532-7361 [Electronic] United States
• PMID: 34340823 (Publication Type: Comparative Study, Journal Article)
• Copyright: Copyright © 2021 Elsevier Inc. All rights reserved.

Chemical References

• Fluorine Radioisotopes
• Radiopharmaceuticals
• fluorocholine
• Technetium Tc 99m Sestamibi
• Choline

Topics

• Choline (administration & dosage, analogs & derivatives, economics)
• Cost-Benefit Analysis (statistics & numerical data)
• Fluorine Radioisotopes (administration & dosage, economics)
• Four-Dimensional Computed Tomography (economics)
• Humans
• Hyperparathyroidism, Primary (diagnosis, economics, etiology, surgery)
• Medicare (economics, statistics & numerical data)
• Models, Economic
• Parathyroid Glands (diagnostic imaging, pathology, surgery)
• Parathyroid Neoplasms (complications, diagnosis, economics, surgery)
• Parathyroidectomy
• Positron Emission Tomography Computed Tomography (economics)
• Positron-Emission Tomography (economics, methods)
• Preoperative Care (economics, methods)
• Quality-Adjusted Life Years
• Radiopharmaceuticals (administration & dosage, economics)
• Sensitivity and Specificity
• Technetium Tc 99m Sestamibi (administration & dosage, economics)
• Ultrasonography (economics)
• United States