Study explores cost-effectiveness of different PSMA PET imaging agents
A new economic modeling study is offering insight into the cost-effectiveness of several popular prostate-specific membrane antigen (PSMA)-targeted PET imaging agents.
According to the analysis, piflufolastat F-18 outperforms several comparable diagnostic options in terms of quality-adjusted life-years. Researchers say their findings suggest that the agent could provide an economic advantage in the staging of men with newly diagnosed local or regional prostate cancer.
“The poor sensitivity of [conventional imaging] modalities in detecting [biochemical recurrence] and distant/metastatic disease has prompted interest in novel PET imaging methods with higher sensitivity and specificity,” Christopher W. Yee, with the Boston-based Analysis Group, and colleagues noted. “With improvement in imaging techniques, the accuracy of prostate cancer staging and localization may increase, promoting better treatment decisions, earlier identification of progression and improved patient outcomes.”
The analysis compared piflufolastat F-18 with flotufolastat F-18, gallium-68 PSMA-11 and conventional imaging, which included bone scans, computed tomography and magnetic resonance imaging. Researchers developed a hybrid model combining a decision tree to evaluate diagnostic and treatment pathways to project long-term outcomes.
Model inputs were drawn from clinical trials, as well as public data and published literature. The analysis accounted for treatment strategies such as prostatectomy, radiation therapy, androgen deprivation therapy, a combination of radiation and androgen deprivation therapy, and active surveillance. Costs included imaging, prostate cancer treatment, medical care and management of adverse events.
Piflufolastat F-18 produced the highest projected survival and quality-adjusted survival. The model estimated 6.79 life-years and 5.23 quality-adjusted life-years with piflufolastat F-18. Corresponding estimates were 6.75 life-years and 5.19 quality-adjusted life-years for PSMA-11, 6.51 and 4.93 for flotufolastat F-18, and 6.5 and 4.92 for conventional imaging.
Piflufolastat F-18 also had the highest net monetary benefit, at $588,702, using a willingness-to-pay threshold of $150,000 per quality-adjusted life-year. Its incremental cost-effectiveness ratios compared with flotufolastat F-18, PSMA-11 and conventional imaging were $762, $91,985 and $138,434 per additional quality-adjusted life-year.
At that willingness-to-pay threshold, the model estimated a 100% probability that piflufolastat F-18 would be cost-effective compared with flotufolastat F-18, a 78% probability compared with PSMA-11 and a 71% probability compared with conventional imaging. Diagnostic costs, test sensitivity and the probability of cure following treatment were among the most influential model inputs.
While the findings suggest that piflufolastat F-18 is the most cost-effective diagnostic option, the authors noted that their results are projections from a decision-analytic model rather than evidence of differences in observed patient outcomes.
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In addition to her background in journalism, Hannah also has patient-facing experience in clinical settings, having spent more than 12 years working as a registered rad tech. She began covering the medical imaging industry for Innovate Healthcare in 2021.