Performing Gadoxetic Acid-Enhanced MRI After CT for Guiding Curative Treatment of Early-Stage Hepatocellular Carcinoma: A Cost-Effectiveness Analysis.
OBJECTIVE
We determined the cost-effectiveness of two different diagnostic imaging strategies in guiding curative treatment of early-stage hepatocellular carcinoma (HCC).


MATERIALS AND METHODS
We developed a decision analytic model using as its starting point a cohort of patients aged 55 years with early-stage HCC detected at dynamic multiphasic CT and with Child-Pugh class A cirrhosis. The model compared two strategies on the initial workup: conventional CT strategy using dynamic multiphasic CT only and gadoxetic acid-enhanced MRI strategy using additional gadoxetic acid-enhanced MRI after initial CT. A Markov cohort model simulated a cohort of patients after curative or adjuvant treatment, with follow-up over the remaining life expectancy. We analyzed mean life-years gain, quality-adjusted life-years (QALYs), costs per person, and incremental cost-effectiveness ratio (ICER). To evaluate results, we performed one-way, two-way, and probabilistic sensitivity analyses.


RESULTS
The life expectancies and QALY were 7.22 years and 5.08 for the conventional CT strategy and 7.79 years and 5.52 for the gadoxetic acid-enhanced MRI strategy, respectively. The expected costs were $99,770 for conventional CT and $105,025 for gadoxetic acid-enhanced MRI in the United States. The ICER with gadoxetic acid-enhanced MRI was $11,957, as opposed to that with conventional CT, which was lower than the cost-effectiveness threshold of $50,000/QALY. One-way, two-way, and probabilistic sensitivity analyses showed unchanged results over an acceptable range.


CONCLUSION
Gadoxetic acid-enhanced MRI after CT is cost-effective for detecting additional HCC in patients with early-stage HCC who can undergo curative treatment (besides liver transplantation). The cost-effectiveness of gadoxetic acid-enhanced MRI may be considered in the management of patients with early-stage HCC during staging.
['Suh|Chong Hyun|CH|', 'Kim|Kyung Won|KW|', 'Park|Seong Ho|SH|', 'Kim|So Yeon|SY|', 'Woo|Dong-Cheol|DC|', 'Shin|Sangjin|S|', 'Pyo|Junhee|J|', 'Shinagare|Atul B|AB|', 'Ramaiya|Nikhil H|NH|', 'Lim|Young-Suk|YS|']
D000368:Aged D006528:Carcinoma, Hepatocellular D003287:Contrast Media D003362:Cost-Benefit Analysis D003661:Decision Support Techniques D005260:Female D019786:Gadolinium DTPA D006801:Humans D008017:Life Expectancy D008103:Liver Cirrhosis D008113:Liver Neoplasms D008279:Magnetic Resonance Imaging D008297:Male D008390:Markov Chains D008875:Middle Aged D009367:Neoplasm Staging D019057:Quality-Adjusted Life Years D014057:Tomography, X-Ray Computed
hepatocellular carcinoma cost-effectiveness analysis quality-adjusted life-years incremental cost-effectiveness ratios gadoxetic acid–enhanced MRI