He Xiaoning, Wu Jing, Holtorf Anke-Peggy, Rinde Harald, Xie Shuangshuang, Shen Wen, Hou Jiancun, Li Xuehua, Li Ziping, Lai Jiaming, Wang Yuting, Zhang Lin, Wang Jian, Li Xuesong, Ma Kuansheng, Ye Feng, Ouyang Han, Zhao Hong
Department of Health and Pharmacy Administration, School of Pharmaceutical Science and Technology, Tianjin University, Tianjin, China.
Health Outcomes Strategies, Basel, Switzerland.
PLoS One. 2018 Jan 11;13(1):e0191095. doi: 10.1371/journal.pone.0191095. eCollection 2018.
Limited data exists in China on the comparative cost of gadolinium ethoxybenzyl diethylenetriamine magnetic resonance imaging (Gd-EOB-DTPA-MRI) with other imaging techniques. This study compared the total cost of Gd-EOB-DTPA-MRI with multidetector computed tomography (MDCT) and extracellular contrast media-enhanced MRI (ECCM-MRI) as initial imaging procedures in patients with suspected hepatocellular carcinoma (HCC). We developed a decision-tree model on the basis of the Chinese clinical guidelines for HCC, which was validated by clinical experts from China. The model compared the diagnostic accuracy and costs of alternative initial imaging procedures. Compared with MDCT and ECCM-MRI, Gd-EOB-DTPA-MRI imaging was associated with higher rates of diagnostic accuracy, i.e. higher proportions of true positives (TP) and true negatives (TN) with lower false positives (FP). Total diagnosis and treatment cost per patient after the initial Gd-EOB-DTPA-MRI evaluation was similar to MDCT (¥30,360 vs. ¥30,803) and lower than that reported with ECCM-MRI (¥30,360 vs. ¥31,465). Lower treatment cost after initial Gd-EOB-DTPA-MRI was driven by reduced utilization of confirmatory diagnostic procedures and unnecessary treatments. The findings reported that Gd-EOB-DTPA-MRI offered higher diagnostic accuracy compared with MDCT and ECCM-MRI at a comparable cost, which indicates Gd-EOB-DTPA-MRI could be the preferred initial imaging procedure for the diagnosis of HCC in China.
在中国，关于钆塞酸二钠磁共振成像（Gd-EOB-DTPA-MRI）与其他成像技术的成本比较数据有限。本研究比较了Gd-EOB-DTPA-MRI与多排螺旋计算机断层扫描（MDCT）以及细胞外造影剂增强磁共振成像（ECCM-MRI）作为疑似肝细胞癌（HCC）患者初始成像检查的总成本。我们基于中国HCC临床指南开发了一个决策树模型，并由中国临床专家进行了验证。该模型比较了替代初始成像检查的诊断准确性和成本。与MDCT和ECCM-MRI相比，Gd-EOB-DTPA-MRI成像的诊断准确率更高，即真阳性（TP）和真阴性（TN）比例更高，假阳性（FP）更低。在初始Gd-EOB-DTPA-MRI评估后，每位患者的总诊断和治疗成本与MDCT相似（30360元对30803元），且低于ECCM-MRI报告的成本（30360元对31465元）。初始Gd-EOB-DTPA-MRI后治疗成本降低是由于确诊诊断程序和不必要治疗的使用率降低。研究结果表明，与MDCT和ECCM-MRI相比，Gd-EOB-DTPA-MRI在成本相当的情况下具有更高的诊断准确性，这表明Gd-EOB-DTPA-MRI可能是中国HCC诊断的首选初始成像检查。
