Is non-contrast-enhanced magnetic resonance imaging cost-effective for screening of hepatocellular carcinoma?
Introduction: Ultrasonography (US) is the current standard of care for imaging surveillance in patients at risk of hepatocellular carcinoma (HCC). Magnetic resonance imaging (MRI) has been explored as an alternative, given the higher sensitivity of MRI, although this comes at a higher cost. We perfo...
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| Format: | Article |
| Language: | English |
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Wolters Kluwer – Medknow Publications
2024-01-01
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| Series: | Singapore Medical Journal |
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| Online Access: | https://journals.lww.com/10.11622/smedj.2021153 |
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| _version_ | 1823863743016075264 |
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| author | Genevieve Jingwen Tan Chau Hung Lee Yan Sun Cher Heng Tan |
| author_facet | Genevieve Jingwen Tan Chau Hung Lee Yan Sun Cher Heng Tan |
| author_sort | Genevieve Jingwen Tan |
| collection | DOAJ |
| description | Introduction:
Ultrasonography (US) is the current standard of care for imaging surveillance in patients at risk of hepatocellular carcinoma (HCC). Magnetic resonance imaging (MRI) has been explored as an alternative, given the higher sensitivity of MRI, although this comes at a higher cost. We performed a cost-effective analysis comparing US and dual-sequence non-contrast-enhanced MRI (NCEMRI) for HCC surveillance in the local setting.
Methods:
Cost-effectiveness analysis of no surveillance, US surveillance and NCEMRI surveillance was performed using Markov modelling and microsimulation. At-risk patient cohort was simulated and followed up for 40 years to estimate the patients’ disease status, direct medical costs and effectiveness. Quality-adjusted life years (QALYs) and incremental cost-effectiveness ratio were calculated.
Results:
Exactly 482,000 patients with an average age of 40 years were simulated and followed up for 40 years. The average total costs and QALYs for the three scenarios — no surveillance, US surveillance and NCEMRI surveillance — were SGD 1,193/7.460 QALYs, SGD 8,099/11.195 QALYs and SGD 9,720/11.366 QALYs, respectively.
Conclusion:
Despite NCEMRI having a superior diagnostic accuracy, it is a less cost-effective strategy than US for HCC surveillance in the general at-risk population. Future local cost-effectiveness analyses should include stratifying surveillance methods with a variety of imaging techniques (US, NCEMRI, contrast-enhanced MRI) based on patients’ risk profiles. |
| format | Article |
| id | doaj-art-1de9e8f3939346fe8b879ec26c62d9f5 |
| institution | Kabale University |
| issn | 0037-5675 2737-5935 |
| language | English |
| publishDate | 2024-01-01 |
| publisher | Wolters Kluwer – Medknow Publications |
| record_format | Article |
| series | Singapore Medical Journal |
| spelling | doaj-art-1de9e8f3939346fe8b879ec26c62d9f52025-02-09T10:19:06ZengWolters Kluwer – Medknow PublicationsSingapore Medical Journal0037-56752737-59352024-01-01651232910.11622/smedj.2021153Is non-contrast-enhanced magnetic resonance imaging cost-effective for screening of hepatocellular carcinoma?Genevieve Jingwen TanChau Hung LeeYan SunCher Heng TanIntroduction: Ultrasonography (US) is the current standard of care for imaging surveillance in patients at risk of hepatocellular carcinoma (HCC). Magnetic resonance imaging (MRI) has been explored as an alternative, given the higher sensitivity of MRI, although this comes at a higher cost. We performed a cost-effective analysis comparing US and dual-sequence non-contrast-enhanced MRI (NCEMRI) for HCC surveillance in the local setting. Methods: Cost-effectiveness analysis of no surveillance, US surveillance and NCEMRI surveillance was performed using Markov modelling and microsimulation. At-risk patient cohort was simulated and followed up for 40 years to estimate the patients’ disease status, direct medical costs and effectiveness. Quality-adjusted life years (QALYs) and incremental cost-effectiveness ratio were calculated. Results: Exactly 482,000 patients with an average age of 40 years were simulated and followed up for 40 years. The average total costs and QALYs for the three scenarios — no surveillance, US surveillance and NCEMRI surveillance — were SGD 1,193/7.460 QALYs, SGD 8,099/11.195 QALYs and SGD 9,720/11.366 QALYs, respectively. Conclusion: Despite NCEMRI having a superior diagnostic accuracy, it is a less cost-effective strategy than US for HCC surveillance in the general at-risk population. Future local cost-effectiveness analyses should include stratifying surveillance methods with a variety of imaging techniques (US, NCEMRI, contrast-enhanced MRI) based on patients’ risk profiles.https://journals.lww.com/10.11622/smedj.2021153cost-effectiveness analysishepatocellular carcinomamagnetic resonance imagingultrasound surveillance |
| spellingShingle | Genevieve Jingwen Tan Chau Hung Lee Yan Sun Cher Heng Tan Is non-contrast-enhanced magnetic resonance imaging cost-effective for screening of hepatocellular carcinoma? Singapore Medical Journal cost-effectiveness analysis hepatocellular carcinoma magnetic resonance imaging ultrasound surveillance |
| title | Is non-contrast-enhanced magnetic resonance imaging cost-effective for screening of hepatocellular carcinoma? |
| title_full | Is non-contrast-enhanced magnetic resonance imaging cost-effective for screening of hepatocellular carcinoma? |
| title_fullStr | Is non-contrast-enhanced magnetic resonance imaging cost-effective for screening of hepatocellular carcinoma? |
| title_full_unstemmed | Is non-contrast-enhanced magnetic resonance imaging cost-effective for screening of hepatocellular carcinoma? |
| title_short | Is non-contrast-enhanced magnetic resonance imaging cost-effective for screening of hepatocellular carcinoma? |
| title_sort | is non contrast enhanced magnetic resonance imaging cost effective for screening of hepatocellular carcinoma |
| topic | cost-effectiveness analysis hepatocellular carcinoma magnetic resonance imaging ultrasound surveillance |
| url | https://journals.lww.com/10.11622/smedj.2021153 |
| work_keys_str_mv | AT genevievejingwentan isnoncontrastenhancedmagneticresonanceimagingcosteffectiveforscreeningofhepatocellularcarcinoma AT chauhunglee isnoncontrastenhancedmagneticresonanceimagingcosteffectiveforscreeningofhepatocellularcarcinoma AT yansun isnoncontrastenhancedmagneticresonanceimagingcosteffectiveforscreeningofhepatocellularcarcinoma AT cherhengtan isnoncontrastenhancedmagneticresonanceimagingcosteffectiveforscreeningofhepatocellularcarcinoma |