Cost comparison of 111In-DTPA-octreotide scintigraphy and 68Ga-DOTATOC PET/CT for staging enteropancreatic neuroendocrine tumours

Although somatostatin receptor positron emission tomography (PET)/CT is gaining increasing popularity and has shown its diagnostic superiority in several studies, 111In-diethylenetriaminepentaacetic acid (DTPA)-octreotide is still the current standard for diagnosis of neuroendocrine tumours (NET). The aim of this study was to compare the costs for the two diagnostic tests and the respective consequential costs. From January 2009 to July 2009, 51 consecutive patients with enteropancreatic NET who underwent contrast-enhanced 68Ga-DOTATOC PET/CT (n = 29) or 111In-DTPA-octreotide (mean 3 whole-body scans plus 1.6 low-dose single photon emission computed tomography/CT; n = 22) were included. For cost analysis, direct costs (equipment) and variable costs (material, labour) per examination were calculated. Additionally required CT and/or MRI examinations within the staging process were assessed as consequential costs. An additional deterministic sensitivity analysis was performed. A 68Ga-DOTATOC PET/CT examination yielded total costs (equipment, personnel and material costs) of 548 EUR. On the other hand, an 111In-DTPA-octreotide examination resulted in 827 EUR total costs. Costs for equipment and material had a share of 460 EUR/720 EUR for 68Ga-DOTATOC/111In-DTPA-octreotide and labour costs of 89 EUR/106 EUR. With 68Ga-DOTATOC additional MRI had to be performed in 7% of the patients resulting in a mean of 20 EUR for supplementary imaging per patient; 82% of patients with 111In-DTPA-octreotide needed additional MRI and/or CT resulting in mean additional costs of 161 EUR per patient. 68Ga-DOTATOC PET/CT was considerably cheaper than 111In-DTPA-octreotide with respect to both material and personnel costs. Furthermore, by using 68Ga-DOTATOC PET/CT considerably fewer additional examinations were needed reducing the consequential costs significantly. (orig.)