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Hepatology, First published: 26 October 2018 | https://doi.org/10.1002/hep.30330 Magnetic Resonance Imaging Is Cost‐Effective for Hepatocellular Carcinoma Surveillance in High Risk Patients with Cirrhosis

Hye-Lin Kim, PhD,^1* Jihyun An, MD, PhD,^2* Jae-A Park, BS,³ Seung-Hoo Park, BS,³ Young-Suk Lim, MD, PhD,^2† Eui-Kyung Lee, PhD^3†
¹College of Pharmacy, Sahmyook University, Korea ²Department of Gastroenterology, Asan Medical Center, University of Ulsan College of Medicine, Korea ³School of Pharmacy, Sungkyunkwan University, Korea
^*H-L Kim and J An contributed equally to this work and deserve co-first authorship.
^†Y-S Lim and E-K Lee share co-correspondence.

Corresponding authors:
Eui-Kyung Lee, PhD
School of Pharmacy, Sungkyunkwan University, 2066 Seobu-ro, Jangan-gu, Suwon, Gyeonggi-do 03063, Korea

Young-Suk Lim, MD, PhD
Department of Gastroenterology, Asan Medical Center, University of Ulsan College of Medicine, 88 Olympic-ro 43-gil, Songpa-gu, Seoul 05505, Korea

Abstract

Ultrasonography (US) is generally recommended for the surveillance of hepatocellular carcinoma (HCC) in patients at risk. However, in cirrhotic patients with sufficiently high HCC incidence, surveillance using magnetic resonance imaging (MRI) with liver-specific contrast showed markedly higher sensitivity in detecting early-stage HCC than US. This study aimed to compare the cost-effectiveness of semiannual surveillance using MRI vs. US in patients with compensated cirrhosis, and to identify the population that would gain optimal cost-effectiveness through MRI surveillance. We designed a Markov model to compare the expected costs and quality-adjusted life-years (QALYs), between MRI and US, with a 20-year time horizon, from the healthcare system perspective. The starting age of the cohort was 50 years, and 71% had hepatitis B virus-associated cirrhosis. The cycle length was 6 months. Transition probabilities and costs were obtained mainly from a prospective cohort study (the PRIUS study, NCT01446666). Cost and effectiveness were discounted at 5%. An incremental cost-effectiveness ratio (ICER) was calculated and tested using sensitivity analyses. The cost-effectiveness analysis indicated that the use of MRI incurred $5,562 incremental costs, 0.384 incremental life-years (LY), and 0.221 incremental QALY compared to US. The annual HCC incidence was the most influential factor on the ICER. The ICERs were $14,474/LY and $25,202/QALY at an annual HCC incidence of 3%. When the HCC incidence rate was >1.81%, the ICER was below $50,000/QALY. With increased HCC incidence, MRI surveillance was acceptable as a cost-effective option, even with increased MRI/US cost ratio.

Conclusions

Semiannual surveillance using MRI with liver-specific contrast may be more cost-effective than US in patients with virus-associated compensated cirrhosis at sufficiently high HCC risk despite the higher test cost of MRI.

논문정보

형식Research article
게재일2018년 10월 (BRIC 등록일 2018-11-06)
연구진국내 연구진
분야 의약학 > 약학

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