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

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.国内目前关于钆乙氧基苯二乙三胺磁共振成像（Gadolinium ethoxybenzyl diethylenetriamine magnetic resonance imaging, Gd-EOB-DTPA-MRI）与其他影像学技术的比较成本相关研究数据较为匮乏。本研究针对疑似肝细胞癌（Hepatocellular carcinoma, HCC）患者，对比了以钆乙氧基苯二乙三胺磁共振成像、多探测器计算机断层扫描（Multidetector computed tomography, MDCT）及细胞外对比剂增强磁共振成像（Extracellular contrast media-enhanced MRI, ECCM-MRI）作为初始影像学检查手段的总成本。本研究基于中国肝细胞癌临床诊疗指南构建了决策树模型，并经国内临床专家验证。该模型对比了不同初始影像学检查方案的诊断准确性与诊疗成本。与MDCT及ECCM-MRI相比，钆乙氧基苯二乙三胺磁共振成像的诊断准确率更高，即真阳性（True Positives, TP）、真阴性（True Negatives, TN）占比更高，假阳性（False Positives, FP）占比更低。以钆乙氧基苯二乙三胺磁共振成像作为初始检查后，每位患者的总诊断治疗成本与MDCT组相近（¥30,360 vs ¥30,803），且低于ECCM-MRI组（¥30,360 vs ¥31,465）。初始采用钆乙氧基苯二乙三胺磁共振成像时，患者治疗成本更低的原因在于确诊性检查操作及不必要治疗的使用量减少。研究结果显示，与MDCT及ECCM-MRI相比，钆乙氧基苯二乙三胺磁共振成像在获得更高诊断准确率的同时，成本相当，这表明钆乙氧基苯二乙三胺磁共振成像可作为国内肝细胞癌诊断的首选初始影像学检查方案。