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Table 1 Decision table based on the diagnostic outcomes of the PEPPER-study cohort

From: Cost-effectiveness of the implementation of [68Ga]Ga-PSMA-11 PET/CT at initial prostate cancer staging

Ground truth Diagnosis Patients (n) Frequency (%) SE (%) ePLND spared (y/n) Diagnostic scheme Curative treatment scheme Health state
[68Ga]Ga-PSMA-11 PET/CT scenario
N0 patients
pN0 pN0 49 91% - No GPP + MRI + ePLND RT/RP NEOD-N0
pN0 iN1lim 5 9% 3.9% Yes*** GPP + MRI RT/RP + Pelvic RT + ADT NEOD-N0
pN0 iN1ext 0 NA***** - Yes** NA NA NA
N1Lim patients
pN1lim pN0 24 65% 7.8% No* GPP + MRI + ePLND RT/RP + Pelvic RT + ADT NEOD-N1
pN1lim iN1lim 12 32% - Yes GPP + MRI RT/RP + Pelvic RT + ADT NEOD-N1
pN1lim iN1ext 1 2.7% 2.7% Yes** GPP + MRI NA False palliative
N1Ext patients
pN1ext pN0 0 NA***** - No* NA NA NA
pN1ext iN1lim 1 33% 27.2% Yes*** GPP + MRI RT/RP + Pelvic RT + ADT Palliative
pN1ext iN1ext 2 67% - Yes GPP + MRI NA Palliative
M1 patients
pM1 iM1 8 100% - Yes**** GPP + MRI NA Palliative
Standard of care scenario
N0 patients
pN0 pN0 54 100% - No GPP + MRI + ePLND RT/RP NEOD-N0
N1Lim Patients         
pN1lim pN1lim 37 100% - No GPP + MRI + ePLND RT/RP + Pelvic RT + ADT NEOD-N1
N1Ext patients
pN1ext pN1ext 3 100% - No GPP + MRI + ePLND NA Palliative
M1 Patients         
pM1 pN0 8 100% - No GPP + MRI + ePLND RT/RP Palliative
  1. The proportion was used to define treatment costs and utilities. The patients distribution among states was used as cohort for the Markov simulation. ADT  Androgen deprivation therapy, ePLND extended pelvic lymph node dissection, GPP = [68Ga]Ga-PSMA-11 PET/CT, MRI  magnetic resonance imaging, M1  distant metastasis including extra pelvic lymph node metastasis, bone and/or visceral metastasis, N0  no lymph node metastasis, N1lim  limited lymph nodes metastasis defined as less than or equal to four pelvic lymph node metastasis, N1ext  extended lymph nodes metastasis defined as more than four pelvic lymph node metastasis, NA  not applicable, NEOD  no evidence of disease, PET/CT  positron emission tomography/computed tomography, PSMA  prostate specific membrane antigen, RP  radical prostatectomy, RT  radiotherapy.
  2. *ePLND would reveal misdiagnosis of the [68Ga]Ga-PSMA-11 PET/CT and therefore assuring correct treatment
  3. **Misdiagnosis by [68Ga]Ga-PSMA-11 PET/CT would result in false positive palliative state and thus causing lower treatment effects
  4. ***Misdiagnosis by [68Ga]Ga-PSMA-11 PET/CT would result higher treatment costs for pelvic radiotherapy and ADT but equal outcomes regarding after treatment effects
  5. ****ePLND would not recognize the M1 state resulting in higher treatment costs and lower treatment utilities for these patients in the standard of care. However after treatment effects would be equal
  6. *****It was assumed to be impossible to overestimate more than 4 lymph nodes metastases in N0 patients and vice versa