Saing Sopany, Haywood Phil, Duncan Joanna K, Ma Ning, Cameron Alun L, Goodall Stephen
Centre for Health Economics Research and Evaluation, University of Technology Sydney, Sydney, New South Wales, Australia.
Australian Safety and Efficacy Register of New Interventional Procedures - Surgical (ASERNIP-S), Royal Australasian College of Surgeons, Adelaide, South Australia, Australia.
ANZ J Surg. 2018 Jun;88(6):E507-E511. doi: 10.1111/ans.14194. Epub 2017 Oct 5.
This study aimed to determine the cost-effectiveness of contrast-enhanced magnetic resonance imaging (CE-MRI) compared with multiphase CE computed tomography (CE-CT) scan to characterize suspected liver lesions in patients with known colorectal carcinoma.
A decision analytic model linking diagnostic accuracy to health outcomes in patients with colorectal carcinoma was constructed. The model assumed that CE-MRI has superior sensitivity and equivalent specificity to CE-CT, and patients with a colorectal liver metastasis could be eligible for curative surgery or chemotherapy and palliation. Delayed diagnosis or misdiagnosis was associated with worse health outcomes (disutility). Cost-effectiveness was calculated as the incremental cost relative to the incremental benefit, the benefit was estimated using quality-adjusted life years. Sensitivity analyses were conducted to test the robustness of the results.
The clinical evidence supports increased sensitivity of CE-MRI compared with CE-CT (0.943 versus 0.768). CE-MRI was more effective and more costly than CE-CT. The incremental cost-effectiveness ratio was estimated to be $40 548 per quality-adjusted life year gained. The model is most sensitive to the cost of MRI, cost of palliative treatment and the disutility associated with delayed palliative care. The results were also sensitive to the assumptions made about the clinical algorithm.
The results provide evidence of the potential cost-effectiveness associated with CE-MRI for the diagnosis of liver metastases in patients with identified colorectal carcinoma. CE-MRI can be recommended as cost-effective provided it replaces CE-CT and that improved diagnostic accuracy results in earlier, curative, disease management.
本研究旨在确定与多期对比增强计算机断层扫描（CE-CT）相比，对比增强磁共振成像（CE-MRI）对已知结直肠癌患者疑似肝脏病变进行特征性诊断的成本效益。
构建了一个将诊断准确性与结直肠癌患者健康结局相联系的决策分析模型。该模型假定CE-MRI比CE-CT具有更高的敏感性和相当的特异性，且结直肠癌肝转移患者可能适合进行根治性手术、化疗或姑息治疗。延迟诊断或误诊与更差 的健康结局（负效用）相关。成本效益计算为相对于增量效益的增量成本，效益使用质量调整生命年进行估计。进行敏感性分析以检验结果的稳健性。
临床证据支持CE-MRI比CE-CT具有更高的敏感性（分别为0.943和0.768）。CE-MRI比CE-CT更有效且成本更高。估计增量成本效益比为每获得一个质量调整生命年40548美元。该模型对MRI成本、姑息治疗成本以及与延迟姑息治疗相关的负效用最为敏感。结果对有关临床算法的假设也很敏感。
结果提供了证据，证明CE-MRI在诊断已确诊结直肠癌患者肝转移方面具有潜在的成本效益。如果CE-MRI取代CE-CT且提高的诊断准确性能带来更早的根治性疾病管理，那么CE-MRI可被推荐为具有成本效益的检查方法。
