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

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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.

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Author information

Authors and Affiliations

  1. Department of Radiology and Research Institute of Radiology, Asan Liver Center, Asan Medical Center, University of Ulsan College of Medicine, 88 Olympic-ro 43-gil, Songpa-gu, Seoul, 138-736, Republic of Korea

    Chong Hyun Suh, Kyung Won Kim & Seong Ho Park

  2. Department of Radiology, Namwon Medical Center, Namwon-si, Republic of Korea

    Chong Hyun Suh

  3. Department of Imaging, Dana-Farber Cancer Institute, Brigham and Women’s Hospital, Harvard Medical School, Boston, MA, USA

    Kyung Won Kim, Atul B. Shinagare, Katherine M. Krajewski & Nikhil H. Ramaiya

  4. Division of Healthcare Technology Assessment Research, Department of Economic Evaluation, National Evidence-based Healthcare Collaborating Agency, Seoul, Republic of Korea

    Sangjin Shin & Jeonghoon Ahn

  5. Collaborating Center for Pharmaceutical Policy and Regulation, Department of Pharmaceutical Science, Utrecht University, Utrecht, Netherlands

    Junhee Pyo

Authors
  1. Chong Hyun Suh
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  2. Kyung Won Kim
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  3. Seong Ho Park
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  4. Sangjin Shin
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  5. Jeonghoon Ahn
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  6. Junhee Pyo
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  7. Atul B. Shinagare
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  8. Katherine M. Krajewski
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  9. Nikhil H. Ramaiya
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Corresponding author

Correspondence to Kyung Won Kim.

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Guarantor

The scientific guarantor of this publication is Kyung Won Kim.

Conflict of interest

The authors of this manuscript declare no relationships with any companies whose products or services may be related to the subject matter of the article.

Funding

This study was supported by a grant (No. 2017R1A2B3011475) from the the National Research Foundation of Korea.

Statistics and biometry

Two of the authors (Kyung Won Kim and Chong Hyun Suh) have significant statistical expertise.

Informed consent

Written informed consent was not required for this study because of the nature of our study, which was a cost-effectiveness analysis.

Ethical approval

Institutional review board approval was not required because of the nature of our study, which was a cost-effectiveness analysis.

Methodology

A cost-effectiveness analysis performed at one institution.

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Suh, C.H., Kim, K.W., Park, S.H. et al. A cost-effectiveness analysis of the diagnostic strategies for differentiating focal nodular hyperplasia from hepatocellular adenoma. Eur Radiol 28, 214–225 (2018). https://doi.org/10.1007/s00330-017-4967-9

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  • DOI: https://doi.org/10.1007/s00330-017-4967-9

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