1 Department of Radiology and Research Institute of Radiology, Asan Liver Center, Asan Medical Center, University of Ulsan College of Medicine, 88 Olympic-ro 43-gil, Songpa-gu, Seoul 138-736, Republic of Korea.
2 Department of Radiology, Namwon Medical Center, Namwon-si, Republic of Korea.
AJR Am J Roentgenol. 2018 Feb;210(2):W63-W69. doi: 10.2214/AJR.17.18300. Epub 2017 Nov 1.
We determined the cost-effectiveness of two different diagnostic imaging strategies in guiding curative treatment of early-stage hepatocellular carcinoma (HCC).
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.
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.
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.
我们旨在确定两种不同的诊断影像学策略在指导早期肝细胞癌（HCC）根治性治疗中的成本效益。
我们使用 55 岁的早期 HCC 患者队列作为起点，这些患者在动态多相 CT 上发现，并伴有 A 级 Child-Pugh 肝硬化，使用该队列开发了决策分析模型。该模型在初始检查中比较了两种策略：仅使用动态多相 CT 的常规 CT 策略和在初始 CT 后使用钆塞酸增强 MRI 的钆塞酸增强 MRI 策略。一个 Markov 队列模型模拟了接受根治性或辅助治疗后的患者队列，对其进行了终生预期的随访。我们分析了人均生命年的增加、质量调整生命年（QALY）、人均成本和增量成本效益比（ICER）。为了评估结果，我们进行了单向、双向和概率敏感性分析。
常规 CT 策略的预期寿命和 QALY 分别为 7.22 年和 5.08，钆塞酸增强 MRI 策略分别为 7.79 年和 5.52。在美国，常规 CT 的预期成本为 99770 美元，钆塞酸增强 MRI 的预期成本为 105025 美元。钆塞酸增强 MRI 的 ICER 为 11957 美元，而常规 CT 的 ICER 低于 50000 美元/QALY 的成本效益阈值。单向、双向和概率敏感性分析在可接受范围内显示结果不变。
在可以进行根治性治疗（除肝移植外）的早期 HCC 患者中，CT 后使用钆塞酸增强 MRI 检测额外 HCC 具有成本效益。在分期过程中，应考虑使用钆塞酸增强 MRI 对早期 HCC 患者进行管理的成本效益。
