Post-ablation PET imaging may not be cost-effective in patients with liver metastases
PET imaging after thermal ablation for colorectal cancer liver metastases may not be cost-effective for most patients, new data suggest.
Colorectal cancer (CRC) most often metastasizes in the liver. The most frequently utilized treatment for this is surgery to remove a portion of the liver, but not all patients are ideal surgical candidates. As such, many providers opt for thermal ablation (when lesions are smaller than 30 mm), which is an effective treatment alternative that carries fewer side effects and lower costs.
Ablation requires post-treatment radiologic monitoring via CT imaging to ensure that all lesions have been removed. However, this method sometimes yields inconclusive results. In these cases, [18F]FDG PET/CT imaging presents an alternative modality for monitoring patients, though experts are divided on whether it is the most appropriate option. Although most radiology organizations agree that [18F]FDG PET/CT can provide valuable information in CRC patients post-treatment, their recommendations differ on its use following ablation.
Experts recently sought to get a better idea of the diagnostic yield of post-ablation PET imaging and whether it is cost-effective for most CRC patients with liver metastases. They conducted an analysis on a group of CRC patients who had undergone ablation and PET imaging within four months of their procedure. The patients also completed monthly contrast-enhanced CT scans and bloodwork.
When calculating the cost-effectiveness of a single PET scan following treatment, the team included costs associated with the exam and any resultant treatment changes. Those figures were then compared to quality-of-life years (QALYs) and survival estimates.
The team described the benefit of [18F]FDG PET/CT in this cohort as negligible. In most cases, the exam did not provide additional information that was not evident on the patients' CT scans or labs. They found that it resulted in treatment changes in less than 5% of patients, and increased costs for patients by around $1,500.
“Since additional [18F]FDG PET/CT 3–4 months after thermal ablation of colorectal liver metastases did not result in a considerable treatment shift, health outcomes also did not improve substantially,” Hendrik Koffijberg, PhD, associate professor at the University of Twente, in the Netherlands, and colleagues explained. “The expected cost increase did not support the hypothesis that additional costs of [18F]FDG PET/CT could be offset by reduced downstream treatment costs.”
The authors suggested that more data in additional subgroups is needed to determine whether the exam would be beneficial in other patients and circumstances.
Learn more about the group’s findings here.
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.