THE CLINICAL AND ECONOMIC EFFECTIVENESS OF THE HEPATOSPECIFIC GADOXETIC ACID–ENHANCED MAGNETIC RESONANCE IMAGING MAGNETIC RESONANCE FOR THE DIAGNOSIS OF HEPATOCELLULAR CARCINOMA IN THE CONDITIONS OF THE HEALTH CARE SYSTEM OF THE REPUBLIC OF KAZAKHSTAN

Abstract

Introduction. Liver cancer is one of the five most common malignant neoplasms of the liver and is the second leading cause of death from cancer worldwide. Currently, there are several potentially curative treatment options in the early stages of the disease and, therefore, the choice of the primary diagnostic method plays a critical role.
Objectives. The aim of this study is to evaluate the cost-effectiveness and impact on the healthcare budget of the Republic of Kazakhstan of the use of magnetic resonance imaging with enhancement of hepatospecific contrast agent gadoxetic acid (MRI with GA) compared with the use of multiphase computed tomography (CT) with contrast and magnetic resonance imaging with enhancement with gadolinium-containing contrast agents (MRI with Gd) for primary diagnosis in patients at high risk of developing HCC.
Methods. A mathematical decision tree model was constructed to estimate costs and compare the cost-effectiveness of using MRI with GA, CT, and MRI with extracellular contrast agents as the primary diagnostic modality in patients with suspected HCC. A budget impact analysis was performed per 1000 patients per year, and the cost-effectiveness ratio, i.e., the likelihood of successful diagnosis of each strategy, was analyzed. The uncertainty of the model parameters was assessed by performing a probabilistic sensitivity analysis.
Results. In the baseline scenario of the model, the performance scores for the compared strategies were different and were 0.811, 0.861, and 0.903 for contrast-enhanced CT, Gd MRI, and GA MRI, respectively. The costs of making a final diagnosis associated with MRI with GA were comparable to the costs of using MRI with Gd (119,209 tenge and 114,255, respectively) and much lower than the costs associated with the use of CT (152,409 tenge). Probabilistic sensitivity analysis for cost-effectiveness analysis showed consistent results in most iterations.
Discussion. Cost-effectiveness analysis showed that the strategy of MRI with GA is the dominant strategy compared to CT, i.e., a more cost-effective strategy for diagnosing HCC in patients with identified focal liver lesions. Regarding the cost-effectiveness comparison of MRI with GA versus MRI with Gd, the former is more expensive and more effective in this analysis, however, cost calculations should be considered in the context of the relevant endpoints and interpreted with regard to the final goals of imaging in patients with suspected HCC.
Conclusions. The GA MRI strategy is a clinically effective and cost-effective strategy for the primary diagnosis of HCC compared to contrast-enhanced CT and traditional gadolinium-enhanced MRI. The data obtained on the clinical and cost-effectiveness of MRI with GA and the potential savings for the healthcare budget associated with it, as well as its non-invasive nature, should be considered in the management of patients at risk with newly diagnosed focal liver lesions.