Cost-Utility Analysis of Non-Contrast Abbreviated Magnetic Resonance Imaging for Hepatocellular Carcinoma Surveillance in Cirrhosis
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Background/Aims: Ultrasonography has a low sensitivity for detecting early-stage hepatocellular carcinoma (HCC) in cirrhotic patients. Non-contrast abbreviated magnetic resonance imaging (aMRI) demonstrated a comparable performance to that of magnetic resonance imaging without the risk of contrast media exposure and at a lower cost than that of full diagnostic MRI. We aimed to investigate the cost-effectiveness of non-contrast aMRI for HCC surveillance in cirrhotic patients, using ultrasonography with alpha-fetoprotein (AFP) as a reference. Methods: Cost-utility analysis was performed using a Markov model in Thailand and the United States. Incremental cost-effectiveness ratios were calculated using the total costs and quality-adjusted life years (QALYs) gained in each strategy. Surveillance protocols were considered cost-effective based on a willingness-to-pay value of $4,665 (160,000 Thai Baht) in Thailand and $50,000 in the United States. Results: aMRI was cost-effective in both countries with incremental cost-effectiveness ratios of $3,667/QALY in Thailand and $37,062/QALY in the United States. Patient-level microsimulations showed consistent findings that aMRI was cost-effective in both countries. By probabilistic sensitivity analysis, aMRI was found to be more cost-effective than combined ultrasonography and AFP with a probability of 0.77 in Thailand and 0.98 in the United States. By sensitivity analyses, annual HCC incidence was revealed as the most influential factor affecting cost-effectiveness. The cost-effectiveness of aMRI increased in settings with a higher HCC incidence. At a higher HCC incidence, aMRI would remain cost-effective at a higher aMRI-to-ultrasonography with AFP cost ratio. Conclusions: Compared to ultrasonography with AFP, non-contrast aMRI is a cost-effective strategy for HCC surveillance and may be useful for such surveillance in cirrhotic patients, especially in those with high HCC risks.
Abstract
Background/Aims: Ultrasonography has a low sensitivity for detecting early-stage hepatocellular carcinoma (HCC) in cirrhotic patients. Non-contrast abbreviated magnetic resonance imaging (aMRI) demonstrated a comparable performance to that of magnetic resonance imaging without the risk of contrast media exposure and at a lower cost than that of full diagnostic MRI. We aimed to investigate the cost-effectiveness of non-contrast aMRI for HCC surveillance in cirrhotic patients, using ultrasonography with alpha-fetoprotein (AFP) as a reference. Methods: Cost-utility analysis was performed using a Markov model in Thailand and the United States. Incremental cost-effectiveness ratios were calculated using the total costs and quality-adjusted life years (QALYs) gained in each strategy. Surveillance protocols were considered cost-effective based on a willingness-to-pay value of $4,665 (160,000 Thai Baht) in Thailand and $50,000 in the United States. Results: aMRI was cost-effective in both countries with incremental cost-effectiveness ratios of $3,667/QALY in Thailand and $37,062/QALY in the United States. Patient-level microsimulations showed consistent findings that aMRI was cost-effective in both countries. By probabilistic sensitivity analysis, aMRI was found to be more cost-effective than combined ultrasonography and AFP with a probability of 0.77 in Thailand and 0.98 in the United States. By sensitivity analyses, annual HCC incidence was revealed as the most influential factor affecting cost-effectiveness. The cost-effectiveness of aMRI increased in settings with a higher HCC incidence. At a higher HCC incidence, aMRI would remain cost-effective at a higher aMRI-to-ultrasonography with AFP cost ratio. Conclusions: Compared to ultrasonography with AFP, non-contrast aMRI is a cost-effective strategy for HCC surveillance and may be useful for such surveillance in cirrhotic patients, especially in those with high HCC risks.
참고문헌 (61)
- Sung H, "Global cancer statistics 2020 : GLOBOCAN estimates of incidence and mortality worldwide for 36 cancers in 185 countries", CA Cancer J Clin, 71, pp.209~249 (2021)
- De Toni EN, "Age independent survival benefit for patients with hepatocellular carcinoma(HCC)without metastases at diagnosis : a population-based study", Gut, 69, pp.168~176 (2020)
- Marrero JA, "Diagnosis, staging, and management of hepatocellular carcinoma : 2018 practice guidance by the American Association for the Study of Liver Diseases", Hepatology, 68, pp.723~750 (2018)
- Tzartzeva K, "Surveillance imaging and alpha fetoprotein for early detection of hepatocellular carcinoma in patients with cirrhosis : a meta-analysis", Gastroenterology, 154, pp.1706~1718 (2018)
- Yu NC, "CT and MRI improve detection of hepatocellular carcinoma, compared with ultrasound alone, in patients with cirrhosis", Clin Gastroenterol Hepatol, 9, pp.161~167 (2011)
- Hanna RF, "Comparative 13-year meta-analysis of the sensitivity and positive predictive value of ultrasound, CT, and MRI for detecting hepatocellular carcinoma", Abdom Radiol(NY), 41, pp.71~90 (2016)
- Park HJ, "Non-enhanced magnetic resonance imaging as a surveillance tool for hepatocellular carcinoma : Comparison with ultrasound", J Hepatol, 72, pp.718~724 (2020)
- Gupta P, "Abbreviated MRI for hepatocellular carcinoma screening : a systematic review and meta-analysis", J Hepatol, 75, pp.108~119 (2021)
- Singal AG, "Effectiveness of hepatocellular carcinoma surveillance in patients with cirrhosis", Cancer Epidemiol Biomarkers Prev, 21, pp.793~799 (2012)
- Chan MV, "Noncontrast MRI for hepatocellular carcinoma detection : a systematic review and meta-analysis : a potential surveillance tool?", Clin Gastroenterol Hepatol, 20, pp.44~56 (2022)
- Arguedas MR, "Screening for hepatocellular carcinoma in patients with hepatitis C cirrhosis : a cost-utility analysis", Am J Gastroenterol, 98, pp.679~690 (2003)
- Goossens N, "Cost-effectiveness of risk score-stratified hepatocellular carcinoma screening in patients with cirrhosis", Clin Transl Gastroenterol, 8, pp.e101~ (2017)
- Husereau D, "Consolidated Health Economic Evaluation Reporting Standards 2022(CHEERS 2022)statement : updated reporting guidance for health economic evaluations", Value Health, 25, pp.3~9 (2022)
- European Association for the Study of the Liver, "EASL Clinical Practice Guidelines : management of hepatocellular carcinoma", J Hepatol, 69, pp.182~236 (2018)
- "Surveillance, Epidemiology, and End Results (SEER) program" (2022)[URL]
- Yang JD, "Impact of country of birth on age at the time of diagnosis of hepatocellular carcinoma in the United States", Cancer, 123, pp.81~89 (2017)
- Omata M, "Asia-Pacific clinical practice guidelines on the management of hepatocellular carcinoma : a 2017 update", Hepatol Int, 11, pp.317~370 (2017)
- Fattovich G, "Natural history of chronic hepatitis B : special emphasis on disease progression and prognostic factors", J Hepatol, 48, pp.335~352 (2008)
- Ioannou GN, "Incidence and predictors of hepatocellular carcinoma in patients with cirrhosis", Clin Gastroenterol Hepatol, 5, pp.938~945 (2007)
- Toh MR, "Global epidemiology and genetics of hepatocellular carcinoma", Gastroenterology, 164, pp.766~782 (2023)
- Orci LA, "Incidence of hepatocellular carcinoma in patients with nonalcoholic fatty liver disease : a systematic review, meta-analysis, and meta-regression", Clin Gastroenterol Hepatol, 20, pp.283~292 (2022)
- Ganne-Carrié N, "Estimate of hepatocellular carcinoma incidence in patients with alcoholic cirrhosis", J Hepatol, 69, pp.1274~1283 (2018)
- Kim HL, "Magnetic resonance imaging is cost-effective for hepatocellular carcinoma surveillance in high-risk patients with cirrhosis", Hepatology, 69, pp.1599~1613 (2019)
- Cadier B, "Early detection and curative treatment of hepatocellular carcinoma : a cost-effectiveness analysis in France and in the United States", Hepatology, 65, pp.1237~1248 (2017)
- Teerawattananon Y, "The use of economic evaluation for guiding the pharmaceutical reimbursement list in Thailand", Z Evid Fortbild Qual Gesundhwes, 108, pp.397~404 (2014)
- Neumann PJ, "Updating cost-effectiveness : the curious resilience of the $50, 000-per-QALY threshold", N Engl J Med, 371, pp.796~797 (2014)
- Gold MR, "Cost-effectiveness in health and medicine" (1996), Oxford University Press
- Chaikledkaew U, "Guidelines for health technology assessment in Thailand(second edition) : the development process", J Med Assoc Thai, 97(Suppl 5), pp.S4~S9 (2014)
- Parikh ND, "Costeffectiveness of hepatocellular carcinoma surveillance : an assessment of benefits and harms", Am J Gastroenterol, 115, pp.1642~1649 (2020)
- Besa C, "Hepatocellular carcinoma detection : diagnostic performance of a simulated abbreviated MRI protocol combining diffusion-weighted and T1-weighted imaging at the delayed phase post gadoxetic acid", Abdom Radiol(NY), 42, pp.179~190 (2017)
- Marqueen KE, "Cost-effectiveness analysis of selective internal radiotherapy with yttrium-90 versus sorafenib in locally advanced hepatocellular carcinoma", JCO Oncol Pract, 17, pp.e266~e277 (2021)
- Reiss KA, "Starting dose of sorafenib for the treatment of hepatocellular carcinoma : a retrospective, multi-institutional study", J Clin Oncol, 35, pp.3575~3581 (2017)
- "Health & drug plans" (2023)[URL]
- Su D, "Cost-effectiveness of atezolizumab plus bevacizumab vs sorafenib as first-line treatment of unresectable hepatocellular carcinoma", JAMA Netw Open, 4, pp.e210037~ (2021)
- Siegel JE, "Recommendations for reporting cost-effectiveness analyses. Panel on Cost-Effectiveness in Health and Medicine", JAMA, 276, pp.1339~1341 (1996)
- McLernon DJ, "Health-state utilities in liver disease : a systematic review", Med Decis Making, 28, pp.582~592 (2008)
- Lima PH, "Cost-utility analysis of imaging for surveillance and diagnosis of hepatocellular carcinoma", AJR Am J Roentgenol, 213, pp.17~25 (2019)
- McKay A, "A cost-utility analysis of treatments for malignant liver tumours : a pilot project", HPB(Oxford), 9, pp.42~51 (2007)
- Cucchetti A, "Cost-effectiveness of semi-annual surveillance for hepatocellular carcinoma in cirrhotic patients of the Italian Liver Cancer population", J Hepatol, 56, pp.1089~1096 (2012)
- Leung HW, "Cost-effectiveness of sorafenib versus SBRT for unresectable advanced hepatocellular carcinoma", Radiat Oncol, 11, pp.69~ (2016)
- Cammà C, "Cost-effectiveness of sorafenib treatment in field practice for patients with hepatocellular carcinoma", Hepatology, 57, pp.1046~1054 (2013)
- Kim SY, "MRI with liver-specific contrast for surveillance of patients with cirrhosis at high risk of hepatocellular carcinoma", JAMA Oncol, 3, pp.456~463 (2017)
- Chaiteerakij R, "Surveillance for hepatocellular carcinoma reduces mortality : an inverse probability of treatment weighted analysis", Ann Hepatol, 16, pp.421~429 (2017)
- Cabrera R, "A real-world observational cohort of patients with hepatocellular carcinoma : design and rationale for TARGET-HCC", Hepatol Commun, 5, pp.538~547 (2020)
- Kanwal F, "Potentially curative treatment in patients with hepatocellular cancer : results from the liver cancer research network", Aliment Pharmacol Ther, 36, pp.257~265 (2012)
- Kuo KL, "Treatment patterns and outcomes in patients with hepatocellular carcinoma stratified by stage-guided treatment categories", J Natl Compr Canc Netw, 13, pp.987~994 (2015)
- Park JW, "Global patterns of hepatocellular carcinoma management from diagnosis to death : the BRIDGE Study", Liver Int, 35, pp.2155~2166 (2015)
- "The Standard Cost List for Health Technology Assessment" (2023)[URL]
- "Medical Expense Database" (2023)[URL]
- "Physician Fee Schedule" (2023)[URL]
- European Association for the Study of the Liver, "EASLEORTC clinical practice guidelines : management of hepatocellular carcinoma", J Hepatol, 56, pp.908~943 (2012)
- Kaplan RM, "Health-related quality of life measurement for evaluation research and policy analysis", Health Psychol, 1, pp.61~80 (1982)
- Kanwal F, "Risk of hepatocellular cancer in HCV patients treated with direct-acting antiviral agents", Gastroenterology, 153, pp.996~1005 (2017)
- Vandecaveye V, "Diffusionweighted MRI provides additional value to conventional dynamic contrast-enhanced MRI for detection of hepatocellular carcinoma", Eur Radiol, 19, pp.2456~2466 (2009)
- Yen YH, "Adherence to the modified Barcelona Clinic Liver Cancer guidelines : results from a high-volume liver surgery center in East Asias", PLoS One, 16, pp.e0249194~ (2021)
- Nguyen MH, "Gaps in hepatocellular carcinoma surveillance in a United States cohort of insured patients with cirrhosis", Curr Med Res Opin, 38, pp.2163~2173 (2022)
- Hosaka T, "Long-term entecavir treatment reduces hepatocellular carcinoma incidence in patients with hepatitis B virus infection", Hepatology, 58, pp.98~107 (2013)
- Demirtas CO, "ALBI grade : evidence for an improved model for liver functional estimation in patients with hepatocellular carcinoma", JHEP Rep, 3, pp.100347~ (2021)
- Zhang BH, "Randomized controlled trial of screening for hepatocellular carcinoma", J Cancer Res Clin Oncol, 130, pp.417~422 (2004)
- Papatheodoridis G, "PAGE-B predicts the risk of developing hepatocellular carcinoma in Caucasians with chronic hepatitis B on 5-year antiviral therapy", J Hepatol, 64, pp.800~806 (2016)
- Velázquez RF, "Prospective analysis of risk factors for hepatocellular carcinoma in patients with liver cirrhosis", Hepatology, 37, pp.520~527 (2003)