Adopting 18F-FDG PET/CT in routine first-line follow-up after thermal ablation therapy in patients with resectable colorectal liver metastases – An explorative cost-effectiveness analysis based on clinical trial data

This comparative study was conducted to assess, in terms of cost-effectiveness, the clinical benefits of adopting 18F-FDG PET/CT to conventional contrast-enhanced CT (CECT) imaging for patients with oligometastatic colorectal liver metastases (CRLM) after receiving thermal ablation (TA) therapy in first-line follow-up. It was investigated whether the routine use of 18F-FDG PET/CT in first-line follow-up cost-effectively improves health outcomes through improved clinical decision-making and patient management. The study design was twofold. First, we conducted a single-centre multidisciplinary clinical trial complemented by retrospectively searching the hospital’s electronic patient database. Second, we conducted a treatment-driven discrete event simulation (DES). Individual patient data collected in the clinical trial were analysed to determine accurate input parameter values for the DES study. Adopting 18F-FDG PET/CT in first-line follow-up was not proven to be a cost-effective alternative to conventional follow-up by CECT. Consequently, our health economic results are in line with previously published cost-effectiveness studies. It is suggested that the use of 18F-FDG PET/CT may lead to a change in the originally planned patient management in up to 20% of all CRLM patients.