Is non-contrast-enhanced magnetic resonance imaging cost-effective for screening of hepatocellular carcinoma?

被引:0
作者
Tan, Genevieve [1 ,5 ]
Lee, Chau [2 ]
Sun, Yan [3 ]
Tan, Cher [4 ]
机构
[1] Khoo Teck Puat Hosp, Dept Radiol, Singapore, Singapore
[2] Tan Tock Seng Hosp, Dept Radiol, Tan Tock Seng, Singapore
[3] Health Serv & Outcomes Res, Natl Healthcare Grp, Singapore, Singapore
[4] Nanyang Technol Univ, Lee Kong Chian Sch Med, Singapore, Singapore
[5] Khoo Teck Puat Hosp, Dept Radiol, 90 Yishun Cent, Singapore 768828, Singapore
关键词
Cost-effectiveness analysis; hepatocellular carcinoma; magnetic resonance imaging; ultrasound surveillance; DYSPLASTIC NODULES; DIAGNOSTIC PERFORMANCE; NATURAL-HISTORY; LIVER; CIRRHOSIS; MRI; SONOGRAPHY; OUTCOMES; RISK; EPIDEMIOLOGY;
D O I
10.11622/smedj.2021153
中图分类号
R5 [内科学];
学科分类号
1002 ; 100201 ;
摘要
Introduction: Ultrasonography (US) is the current standard of care for imaging surveillance in patients at risk of hepatocellular carcinoma (HCC). Magnetic resonance imaging (MRI) has been explored as an alternative, given the higher sensitivity of MRI, although this comes at a higher cost. We performed a cost-effective analysis comparing US and dual-sequence non-contrast-enhanced MRI (NCEMRI) for HCC surveillance in the local setting. Methods: Cost-effectiveness analysis of no surveillance, US surveillance and NCEMRI surveillance was performed using Markov modelling and microsimulation. At-risk patient cohort was simulated and followed up for 40 years to estimate the patients' disease status, direct medical costs and effectiveness. Quality-adjusted life years (QALYs) and incremental cost-effectiveness ratio were calculated. Results: Exactly 482,000 patients with an average age of 40 years were simulated and followed up for 40 years. The average total costs and QALYs for the three scenarios - no surveillance, US surveillance and NCEMRI surveillance - were SGD 1,193/7.460 QALYs, SGD 8,099/11.195 QALYs and SGD 9,720/11.366 QALYs, respectively. Conclusion: Despite NCEMRI having a superior diagnostic accuracy, it is a less cost-effective strategy than US for HCC surveillance in the general at-risk population. Future local cost-effectiveness analyses should include stratifying surveillance methods with a variety of imaging techniques (US, NCEMRI, contrast-enhanced MRI) based on patients' risk profiles.
引用
收藏
页码:23 / 29
页数:7
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