Cost-effectiveness of EOB-MRI for Hepatocellular Carcinoma in Japan

Akihiro Nishie; Satoshi Goshima; Hiroki Haradome; Etsuro Hatano; Yasuharu Imai; Masatoshi Kudo; Masanori Matsuda; Utaroh Motosugi; Satoshi Saitoh; Kengo Yoshimitsu; Bruce Crawford; Eliza Kruger; Graeme Ball; Hiroshi Honda

doi:10.1016/j.clinthera.2017.03.006

Cost-effectiveness of EOB-MRI for Hepatocellular Carcinoma in Japan

Clin Ther. 2017 Apr;39(4):738-750.e4. doi: 10.1016/j.clinthera.2017.03.006. Epub 2017 Mar 29.

Authors

Akihiro Nishie¹, Satoshi Goshima², Hiroki Haradome³, Etsuro Hatano⁴, Yasuharu Imai⁵, Masatoshi Kudo⁶, Masanori Matsuda⁷, Utaroh Motosugi⁷, Satoshi Saitoh⁸, Kengo Yoshimitsu⁹, Bruce Crawford¹⁰, Eliza Kruger¹⁰, Graeme Ball¹⁰, Hiroshi Honda¹¹

Affiliations

¹ Kyushu University, Fukuoka, Japan. Electronic address: anishie@radiol.med.kyushu-u.ac.jp.
² Gifu University Hospital, Gifu, Japan.
³ Nihon University Hospital, Tokyo, Japan.
⁴ Hyogo University Hospital, Hyogo, Japan.
⁵ Ikeda Municipal Hospital, Osaka, Japan.
⁶ Kindai University Hospital, Osaka, Japan.
⁷ Yamanashi University, Yamanashi, Japan.
⁸ Toranomon Hospital, Tokyo, Japan.
⁹ Fukuoka University Hospital, Fukuoka, Japan.
¹⁰ QuintilesIMS, Tokyo, Japan.
¹¹ Kyushu University, Fukuoka, Japan.

PMID: 28363694
DOI: 10.1016/j.clinthera.2017.03.006

Abstract

Purpose: The objective of the study was to evaluate the cost-effectiveness of gadoxetic acid-enhanced magnetic resonance imaging (EOB-MRI) in the diagnosis and treatment of hepatocellular carcinoma (HCC) in Japan compared with extracellular contrast media-enhanced MRI (ECCM-MRI) and contrast media-enhanced computed tomography (CE-CT) scanning.

Methods: A 6-stage Markov model was developed to estimate lifetime direct costs and clinical outcomes associated with EOB-MRI. Diagnostic sensitivity and specificity, along with clinical data on HCC survival, recurrence, treatment patterns, costs, and health state utility values, were derived from predominantly Japanese publications. Parameters unavailable from publications were estimated in a Delphi panel of Japanese clinical experts who also confirmed the structure and overall approach of the model. Sensitivity analyses, including one-way, probabilistic, and scenario analyses, were conducted to account for uncertainty in the results.

Findings: Over a lifetime horizon, EOB-MRI was associated with lower direct costs (¥2,174,869) and generated a greater number of quality-adjusted life years (QALYs) (9.502) than either ECCM-MRI (¥2,365,421, 9.303 QALYs) or CE-CT (¥2,482,608, 9.215 QALYs). EOB-MRI was superior to the other diagnostic strategies considered, and this finding was robust over sensitivity and scenario analyses. A majority of the direct costs associated with HCC in Japan were found to be costs of treatment. The model results revealed the superior cost-effectiveness of the EOB-MRI diagnostic strategy compared with ECCM-MRI and CE-CT.

Implications: EOB-MRI could be the first-choice imaging modality for medical care of HCC among patients with hepatitis or liver cirrhosis in Japan. Widespread implementation of EOB-MRI could reduce health care expenditures, particularly downstream treatment costs, associated with HCC.

Keywords: CT; MRI; cost; economic evaluation; gadoxetic acid; hepatocellular carcinoma; liver imaging.

MeSH terms

Carcinoma, Hepatocellular / diagnostic imaging*
Carcinoma, Hepatocellular / economics*
Contrast Media
Cost-Benefit Analysis
Gadolinium DTPA
Humans
Japan
Liver Neoplasms / diagnostic imaging*
Liver Neoplasms / economics*
Magnetic Resonance Imaging / economics*
Magnetic Resonance Imaging / methods*
Quality-Adjusted Life Years
Tomography, X-Ray Computed / methods

Substances

Contrast Media
gadolinium ethoxybenzyl DTPA
Gadolinium DTPA