Cost evaluation of gadoxetic acid-enhanced magnetic resonance imaging in the diagnosis of colorectal-cancer metastasis in the liver: Results from the VALUE Trial

Abstract

ObjectivesTo assess the costs of diagnostic workup and surgery of three strategies for patients with colorectal cancer liver-metastases (CRCLM): gadoxetic-acid-enhanced MRI (Gd-EOB-DTPA-MRI), MRI with extracellular contrast-media (ECCM-MRI) or contrast-enhanced MDCT (CE-MDCT).MethodsThe within-trial cost evaluation was modelled as a decision-tree to calculate the cost of diagnosis and surgery. The model used clinical outcomes and resource utilization data from a prospective randomized multicentre study. Analyses were performed for the 354-patient safety population from eight participating countries.ResultsThe diagnostic workup cost using Gd-EOB-DTPA-MRI upfront resulted in savings compared to ECCM-MRI in all countries except Thailand (difference <2 %). Compared to CE-MDCT, initial imaging with Gd-EOB-DTPA-MRI was less costly in all countries except Korea and Spain (differences 4 and 8 %, respectively). Significantly more patients in the Gd-EOB-DTPA-MRI group were eligible for surgery (39.3 % (48/122) vs. 31.0 % (36/116) and 26.7 % (31/116) for ECCM-MRI and CE-MDCT, respectively), allowing more patients to undergo potentially curative surgery, but resulting in higher treatment costs for the strategy starting with Gd-EOB-DTPA-MRI.ConclusionsThe benefits of Gd-EOB-DTPA-MRI due to less additional imaging and similar diagnostic workup costs in the three groups suggest that Gd-EOB-DTPA-MRI should be the preferred initial imaging procedure to evaluate hepatic resectability in patients with CRCLM.Key Points• Diagnostic imaging cost to evaluate resectability was similar among the groups • Cost for imaging was rather small compared to the cost of surgery • Significantly more patients in the Gd-EOB-DTPA-MRI arm were eligible for surgery • Gd-EOB-DTPA-MRI is recommended for evaluating hepatic resectability in patients with CRCLM Electronic supplementary materialThe online version of this article (doi:10.1007/s00330-016-4271-0) contains supplementary material, which is available to authorized users.

Health economic assessment of Gd-EOB-DTPA MRI versus ECCM-MRI and multi-detector CT for diagnosis of hepatocellular carcinoma in China

“…Similar cost evaluation model used in the multinational VALUE trial (conducted in Switzerland, Sweden, Austria, South Korea and Thailand) also reported less requirement of subsequent imaging and similar diagnostic costs of Gd-EOB-DTPA-MRI compared with alternative diagnoses. These findings supported the use of Gd-EOB-DTPA-MRI as recommended initial diagnostic procedure [ 41 ]. A similar health economic model was employed by radiologists and clinical experts to compare the costs of the diagnostic procedures for HCC patients in Korea and Thailand.…”

Abbreviated MRI protocol for colorectal liver metastases: How the radiologist could work in pre surgical setting

“…Consequently, it will be possible to study about three patients during the same time used for one patient. Also, although the exact costs of liver MRI are highly variable between different centers and countries, and it is correlated also to the contrast medium administrated; the available literature estimates a price range between to $105,02 and $3403,00 for Gd-EOB-DTPA MRI study [42][43][44][45][46]. As clinical implementation of fast MRI could save approximately 50% of costs.…”

Synchronous and metachronous liver metastases in patients with colorectal cancer—towards a clinically relevant definition

“…A randomized trial has shown that MRI with liver-specific contrast is superior for detection of CRCLM, as compared to contrast-enhanced CT and MRI with extracellular contrast [63]. Health economic studies suggest that an MRI first approach is from a cost perspective comparable to a step-up approach with contrast-enhanced CT first [64, 65].…”