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

Purpose Although somatostatin receptor positron emission tomography (PET)/CT is gaining increasing popularity and has shown its diagnostic superiority in several studies, In-111-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. Methods From January 2009 to July 2009, 51 consecutive patients with enteropancreatic NET who underwent contrast-enhanced Ga-68-DOTATOC PET/CT (n = 29) or In-111-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. Results A Ga-68-DOTATOC PET/CT examination yielded total costs (equipment, personnel and material costs) of 548 a,not sign. On the other hand, an In-111-DTPA-octreotide examination resulted in 827 a,not sign total costs. Costs for equipment and material had a share of 460 a,not sign/720 a,not sign for Ga-68-DOTATOC/In-111-DTPA-octreotide and labour costs of 89 a,not sign/106 a,not sign. With Ga-68-DOTATOC additional MRI had to be performed in 7% of the patients resulting in a mean of 20 a,not sign for supplementary imaging per patient; 82% of patients with In-111-DTPA-octreotide needed additional MRI and/or CT resulting in mean additional costs of 161 a,not sign per patient. Conclusion Ga-68-DOTATOC PET/CT was considerably cheaper than In-111-DTPA-octreotide with respect to both material and personnel costs. Furthermore, by using Ga-68-DOTATOC PET/CT considerably fewer additional examinations were needed reducing the consequential costs significantly.