First-line [¹⁸F]F-choline PET/CT in primary hyperparathyroidism: a cost-effectiveness study from the diagnostic...

Area of Science:

• Nuclear Medicine
• Radiopharmaceuticals
• Surgical Management

Background:

• The APACH2 trial demonstrated [18F]F-choline (FCH1) PET/CT's superiority over [99mTc]Tc-sesta MIBI (MIBI1) SPECT/CT for guiding primary hyperparathyroidism (pHPT) surgery.
• This study aimed to evaluate the cost-effectiveness of the superior FCH1 imaging strategy compared to MIBI1.

Purpose of the Study:

• To determine the incremental cost-effectiveness ratio (ICER) of using first-line [18F]F-choline PET/CT versus [99mTc]Tc-sesta MIBI SPECT/CT for patients with primary hyperparathyroidism.
• To assess the clinical gain of FCH1 imaging against its increased cost from a payer's perspective.

Main Methods:

• A randomized controlled multicentre trial (APACH2) comparing FCH1 and MIBI1 imaging strategies.
• Effectiveness was measured by the rate of normocalcemia one month post-surgery.
• Medico-economic analysis integrated direct hospital costs up to six months, calculating the ICER and performing sensitivity analyses.

Main Results:

• The FCH1 strategy showed a differential effectiveness of 29% (85% vs 56%) compared to MIBI1 (p=0.037).
• The average cost difference was €136.5, with an ICER of €471 for FCH1, indicating the cost to cure one additional patient.
• Sensitivity analyses confirmed FCH1 as slightly more expensive but more effective.

Conclusions:

• First-line [18F]F-choline PET/CT facilitates direct referral of more pHPT patients to successful minimally invasive parathyroidectomy.
• This improved surgical management is achieved at a minimal additional cost from a health insurance perspective.