Health economic evaluation of Gd-EOB-DTPA MRI vs ECCM-MRI and multi-detector computed tomography in patients with suspected hepatocellular carcinoma in Thailand and South Korea

Lee, Jeong Min; Kim, Do Young; Phongkitkarun, Sith; Sobhonslidsuk, Abhasnee; Holtorf, Anke-Peggy; Rinde, Harald; Bergmann, Karsten

doi:10.3111/13696998.2016.1171230

Cited by 16 publications

(13 citation statements)

References 23 publications

(30 reference statements)

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“…Consequently, if the US quality is inadequate (i.e., category C or, in some cases, category B), we recommend considering other imaging modalities (e.g., CT scans or magnetic resonance imaging [MRI]) for HCC screening (Proposal 5). Compared with multidetector CT (MDCT) and extracellular contrast media-enhanced MRI (ECCM-MRI), Gd-EOB-DTPA-MRI can be used as the first-choice imaging modality for the medical care of HCC among patients with hepatitis or liver cirrhosis in Japan [54], China [55], Thailand, and Korea [56]. The optimal intervals of imaging studies remain obscure.…”

Section: Hcc Surveillance In Nafld Advocated By the American Gastroenmentioning

confidence: 99%

Surveillance of Hepatocellular Carcinoma in Nonalcoholic Fatty Liver Disease

et al. 2020

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Nonalcoholic fatty liver disease (NAFLD) is becoming the leading cause of hepatocellular carcinoma (HCC), liver-related mortality, and liver transplantation. There is sufficient epidemiological cohort data to recommend the surveillance of patients with NAFLD based upon the incidence of HCC. The American Gastroenterology Association (AGA) expert review published in 2020 recommends that NAFLD patients with cirrhosis or advanced fibrosis estimated by non-invasive tests (NITs) consider HCC surveillance. NITs include the fibrosis-4 (FIB-4) index, the enhanced liver fibrosis (ELF) test, FibroScan, and MR elastography. The recommended surveillance modality is abdominal ultrasound (US), which is cost effective and noninvasive with good sensitivity. However, US is limited in obese patients and those with NAFLD. In NAFLD patients with a high likelihood of having an inadequate US, or if an US is attempted but inadequate, CT or MRI may be utilized. The GALAD score, consisting of age, gender, AFP, the lens culinaris-agglutinin-reactive fraction of AFP (AFP-L3), and the protein induced by the absence of vitamin K or antagonist-II (PIVKA-II), can help identify a high risk of HCC in NAFLD patients. Innovative parameters, including a Mac-2 binding protein glycated isomer, type IV collagen 7S, free apoptosis inhibitor of the macrophage, and a combination of single nucleoside polymorphisms, are expected to be established. Considering the large size of the NAFLD population, optimal screening tests must meet several criteria, including high sensitivity, cost effectiveness, and availability.

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Section: Hcc Surveillance In Nafld Advocated By the American Gastroenmentioning

confidence: 99%

Surveillance of Hepatocellular Carcinoma in Nonalcoholic Fatty Liver Disease

et al. 2020

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“…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. The results from the model showed higher diagnostic accuracy with Gd-EOB-FTPA-MRI which led to overall savings in both the countries compared with the alternate procedures [ 23 ]. In China, the current standard-of-care diagnostic process is usage of MDCT or ECCM-MRI initially, as the cost of diagnosis is covered by the Chinese basic medical insurance.…”

Section: Discussionmentioning

confidence: 99%

“…These studies demonstrated a decrease in the number of confirmatory diagnostic procedures and surgeries after initial Gd-EOB-DTPA-MRI diagnosis. Based on the findings, Gd-EOB-DTPA-MRI was considered to be associated with cost savings [ 22 , 23 ]. To date, no health economic evaluation comparing Gd-EOB-DTPA-MRI with other imaging techniques has been conducted in China.…”

Section: Introductionmentioning

confidence: 99%

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

Holtorf³

et al. 2018

PLoS ONE

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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.

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“…It can be observed that Gd-COB-DTPA-enhanced MRI has the lowest cost and the longest QALYs, with the highest clinical benefits [54]. A health economics study also revealed that the cost of using Gd-EOB-DTPA for enhanced MRI in the diagnosis of suspected HCC patients in South Korea was lower than that of ECCM-MRI and multi-row spiral CT, from the perspective of both patients and hospitals [55]. The results for the health economics in China revealed that the total cost of diagnosis and treatment of patients using Gd-EOB-DTPA-enhanced MRI is similar to that of patients who used multi-row spiral CT, when patients visit a doctor for the first time.…”

Section: Deficiencies and Limitationsmentioning

confidence: 99%

Application of Gd-EOB-DTPA-enhanced magnetic resonance imaging (MRI) in hepatocellular carcinoma

et al. 2020

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Background: Hepatocellular carcinoma (HCC) is the most common malignant tumor of the liver, and its morbidity and mortality have been increasing in recent years. The early diagnosis and prompt treatment of small HCC are crucial to improve the prognosis and quality of life of patients. In China, hepatitis B virus infection is the main cause. HCC with a single tumor nodule of ≤ 3 cm in diameter, or HCC with a number of nodules, in which each nodule is ≤ 2 cm in diameter, with a total diameter of ≤ 3 cm, is considered as small HCC. The MRI liver-specific contrast agent can detect small HCC at the early stage. This has important clinical implications for improving the survival rate of patients. Main body: Gd-EOB-DTPA-enhanced MRI can significantly improve the sensitivity and specificity of the detection of HBV-related small hepatocellular carcinoma, providing an important basis for the clinical selection of appropriate personalized treatment. Gd-EOB-DTPA-enhanced MRI can reflect the degree of HCC differentiation, and the evaluation of HCC on Gd-EOB-DTPA-enhanced MRI would be helpful for the selection of the treatment and prognosis of HCC patients. The present study reviews the progress of the application of Gd-EOB-DTPA in the early diagnosis of small HCC, its clinical treatment, the prediction of the degree of differentiation, and the assessment of recurrence and prognosis of HCC, including the pharmacoeconomics and application limitations of Gd-EOB-DTPA. The value of the application of HCC with the Gd-EOB-DTPA was summarized to provide information for improving the quality of life and prolonging the survival of patients. Conclusion: Gd-EOB-DTPA-enhanced MRI has the diagnostic capability for small HCC with a diameter of ≤ 2 cm. This will have a broader application prospect in the early diagnosis of small liver cancer with a diameter of ≤ 1 cm in the future. The relationship between GD-EOB-DTPA-MRI and the degree of HCC differentiation has a large research space, and Gd-EOB-DTPA is expected to become a potential tool for the preoperative prediction and postoperative evaluation of HCC, which would be beneficial for more appropriate treatments for HCC patients.

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Health economic evaluation of Gd-EOB-DTPA MRI vs ECCM-MRI and multi-detector computed tomography in patients with suspected hepatocellular carcinoma in Thailand and South Korea

Abstract: Gd-EOB-DTPA-MRI as an initial imaging procedure in patients with suspected HCC provides better diagnostic certainty and relevant statutory health insurance cost savings in Thailand and Korea, compared with ECCM-MRI and MDCT.

Cited by 16 publications

References 23 publications

Surveillance of Hepatocellular Carcinoma in Nonalcoholic Fatty Liver Disease

Surveillance of Hepatocellular Carcinoma in Nonalcoholic Fatty Liver Disease

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

Application of Gd-EOB-DTPA-enhanced magnetic resonance imaging (MRI) in hepatocellular carcinoma

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