Cost comparison of ¹¹¹In-DTPA-octreotide scintigraphy and ⁶⁸Ga-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, ¹¹¹Indiethylenetriaminepentaacetic 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 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. Results: A ⁶⁸Ga-DOTATOC PET/CT examination yielded total costs (equipment, personnel and material costs) of 548 €. On the other hand, an ¹¹¹In-DTPA-octreotide examination resulted in 827 € total costs. Costs for equipment and material had a share of 460 €/720 € for ⁶⁸Ga-DOTATOC/ ¹¹¹In-DTPA-octreotide and labour costs of 89 €/106 €. With ⁶⁸Ga-DOTATOC additional MRI had to be performed in 7% of the patients resulting in a mean of 20 € 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 € per patient. Conclusion: 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.