Cost‐effective imaging for resectability of liver lesions in colorectal cancer: an economic decision model

• Published in: ANZ journal of surgery Vol. 88; no. 6; pp. E507 - E511
• Main Authors: Saing, Sopany, Haywood, Phil, Duncan, Joanna K., Ma, Ning, Cameron, Alun L., Goodall, Stephen
• Format: Journal Article
• Language: English
• Published: Melbourne John Wiley & Sons Australia, Ltd 01.06.2018; Blackwell Publishing Ltd
• Subjects: Aged; Australia; Chemotherapy; Colorectal cancer; Colorectal carcinoma; Colorectal Neoplasms - pathology; Colorectal Neoplasms - surgery; Computed tomography; Contrast Media; Cost-Benefit Analysis; cost‐effectiveness; Decision analysis; Decision Support Techniques; Diagnosis; Diagnostic systems; Disease control; economic evaluation; Economic models; Female; Humans; Lesions; Liver; Liver cancer; liver metastasis; Liver Neoplasms - diagnostic imaging; Liver Neoplasms - secondary; Liver Neoplasms - surgery; Magnetic resonance imaging; Magnetic Resonance Imaging - economics; Magnetic Resonance Imaging - methods; Male; Mathematical models; Medical imaging; Metastases; Middle Aged; Model accuracy; Models, Economic; NMR; Nuclear magnetic resonance; Palliation; Patients; Quality-Adjusted Life Years; Risk Assessment; Sensitivity; Sensitivity analysis; Surgery; Tomography, X-Ray Computed - economics; Tomography, X-Ray Computed - methods; Australia; cost-effectiveness; liver metastasis; magnetic resonance imaging; economic evaluation
• DOI: 10.1111/ans.14194
• ISSN: 1445-1433

Background This study aimed to determine the cost‐effectiveness of contrast‐enhanced magnetic resonance imaging (CE‐MRI) compared with multiphase CE computed tomography (CE‐CT) scan to characterize suspected liver lesions in patients with known colorectal carcinoma. Methods A decision analytic model linking diagnostic accuracy to health outcomes in patients with colorectal carcinoma was constructed. The model assumed that CE‐MRI has superior sensitivity and equivalent specificity to CE‐CT, and patients with a colorectal liver metastasis could be eligible for curative surgery or chemotherapy and palliation. Delayed diagnosis or misdiagnosis was associated with worse health outcomes (disutility). Cost‐effectiveness was calculated as the incremental cost relative to the incremental benefit, the benefit was estimated using quality‐adjusted life years. Sensitivity analyses were conducted to test the robustness of the results. Results The clinical evidence supports increased sensitivity of CE‐MRI compared with CE‐CT (0.943 versus 0.768). CE‐MRI was more effective and more costly than CE‐CT. The incremental cost‐effectiveness ratio was estimated to be $40 548 per quality‐adjusted life year gained. The model is most sensitive to the cost of MRI, cost of palliative treatment and the disutility associated with delayed palliative care. The results were also sensitive to the assumptions made about the clinical algorithm. Conclusion The results provide evidence of the potential cost‐effectiveness associated with CE‐MRI for the diagnosis of liver metastases in patients with identified colorectal carcinoma. CE‐MRI can be recommended as cost‐effective provided it replaces CE‐CT and that improved diagnostic accuracy results in earlier, curative, disease management.