A cost-effectiveness analysis of the diagnostic strategies for differentiating focal nodular hyperplasia from hepatocellular adenoma

Chong Hyun Suh, Kyung Won Kim, Seong Ho Park, Sangjin Shin, Jeonghoon Ahn, Junhee Pyo, Atul B. Shinagare, Katherine M. Krajewski, Nikhil H. Ramaiya

Research output: Contribution to journalArticlepeer-review

6 Scopus citations

Abstract

Objectives: We evaluated the cost-effectiveness of a gadoxetic acid-enhanced MRI (EOB-MRI) strategy compared with conventional MRI strategy and biopsy to differentiate focal nodular hyperplasia (FNH) from hepatocellular adenoma (HCA). Methods: A decision tree model was constructed to compare the cost-effectiveness of EOB-MRI, conventional MRI with extracellular contrast agents, and biopsy as the initial diagnostic modality in patients with incidentally detected focal liver lesions suspected of being FNH or HCA. We analysed the cost and effectiveness, i.e. probability of successful diagnosis of each strategy. Costs were based on utilisation rates and Medicare reimbursements in the USA and South Korea. Results: In the base case analysis of our decision tree model, the effectiveness of the three strategies was similar. The cost of the EOB-MRI strategy ($1283 in USA, $813 in South Korea) was lowest compared with the biopsy strategy ($1725 in USA, $847 in South Korea) and the conventional MRI strategy ($1750 in USA, $962 in South Korea). One-way, two-way and probabilistic sensitivity analysis showed unchanged results over an acceptable range. Conclusions: EOB-MRI strategy is the most cost-effective strategy for differentiating FNH from HCA in patients with incidentally detected focal liver lesions in a non-cirrhotic liver. Key points: • The effectiveness of the three strategies was similar. • The cost of the EOB-MRI strategy was lowest. • EOB-MRI strategy is the most cost-effective for differentiating FNH from HCA.

Original languageEnglish
Pages (from-to)214-225
Number of pages12
JournalEuropean Radiology
Volume28
Issue number1
DOIs
StatePublished - 1 Jan 2018

Bibliographical note

Publisher Copyright:
© 2017, European Society of Radiology.

Keywords

  • Cost-effectiveness analysis
  • Decision tree
  • Focal nodular hyperplasia
  • Gadoxetic acid-enhanced MRI
  • Hepatocellular adenoma

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