Cost-Utility Analysis of Imaging for Surveillance and Diagnosis of Hepatocellular Carcinoma.

Authors:
Paulo Henrique Lima
Paulo Henrique Lima
Januário Cicco Maternity School
Boyan Fan
Boyan Fan
Centre hospitalier de l'Université de Montréal (CHUM)
Milena Cerny
Milena Cerny
Centre Hospitalier Universitaire Vaudois
Switzerland
Damien Olivie
Damien Olivie
Rennes F-35000 France; Université de Rennes 1
France
Jeanne-Marie Giard
Jeanne-Marie Giard
Centre de Recherche du Centre Hospitalier de l'Universite de Montreal (CRCHUM)
Canada
Catherine Beauchemin
Catherine Beauchemin
University of Montreal
Canada
An Tang
An Tang
University of Montreal
Canada

AJR Am J Roentgenol 2019 Apr 17:1-9. Epub 2019 Apr 17.

1 Centre de recherche du Centre hospitalier de l'Université de Montréal, Montréal, QC, Canada.

The purpose of this study is to compare imaging-based surveillance and diagnostic strategies in patients at risk for hepatocellular carcinoma (HCC) while taking into account technically inadequate examinations and patient compliance. A Markov model simulated seven strategies for HCC surveillance and diagnosis in patients with cirrhosis: strategy A, ultrasound (US) for surveillance and CT for diagnosis; strategy B, US for surveillance and complete MRI for diagnosis; strategy C, US for surveillance and CT for inadequate or positive surveillance; strategy D, US for surveillance and complete MRI for inadequate or positive surveillance; strategy E, surveillance and diagnosis with CT followed by complete MRI for inadequate surveillance; strategy F, surveillance and diagnosis with complete MRI followed by CT for inadequate surveillance; and strategy G, surveillance with abbreviated MRI followed by CT for inadequate surveillance or complete MRI for positive surveillance. Two compliance scenarios were evaluated: optimal and conservative. For each scenario, the most cost-effective strategy was based on a willingness-to-pay threshold of $50,000 (Canadian) per quality-adjusted life year (QALY). Sensitivity analyses were performed. Base-case analysis revealed that strategy E was the most cost-effective when compliance was optimal ($13,631/QALY), and strategy G was the most cost-effective when compliance was conservative ($39,681/QALY). Sensitivity analyses supported the base-case analysis in the optimal compliance scenario, but several parameters altered the most cost-effective strategy in the conservative compliance scenario. In an optimal compliance scenario, CT for HCC surveillance and diagnosis and complete MRI for inadequate CT was most cost-effective. In a conservative compliance scenario, abbreviated MRI may be an alternative to US-based surveillance.

Download full-text PDF

Source
https://www.ajronline.org/doi/10.2214/AJR.18.20341
Publisher Site
http://dx.doi.org/10.2214/AJR.18.20341DOI Listing
April 2019
4 Reads

Publication Analysis

Top Keywords

surveillance diagnosis
24
strategy surveillance
24
complete mri
24
mri inadequate
20
surveillance
18
compliance scenario
16
surveillance strategy
16
surveillance complete
12
positive surveillance
12
diagnosis complete
12
inadequate surveillance
12
strategy
11
optimal compliance
8
conservative compliance
8
diagnosis strategy
8
mri
8
hcc surveillance
8
cost-effective compliance
8
sensitivity analyses
8
cost-effective strategy
8

Similar Publications