Evaluation of the health economic impact of initial diagnostic modality selection in patients suspected of having HCC in China and the USA

Abstract

Aims

To compare relative costs associated with the diagnostic pathways for hepatocellular carcinoma (HCC) in the US and China according to the initial imaging modality used. Gadoxetate disodium (ethoxylbenzyl-diethylenetriaminepentaacetic acid)-enhanced magnetic resonance imaging (EOB-MRI) was compared to contrast-enhanced multidetector computed tomography (MDCT), extracellular contrast media enhanced-MRI (ECCM-MRI) and contrast-enhanced ultrasound (CEUS).

Materials and methods

Decision tree models were developed to simulate the clinical pathway, based on local clinical guidelines, and validated by experts. Input data were derived from the literature (up to 31 December 2020) as well as from interviews with local experts.

Results

The models showed that compared to alternative initial imaging modalities, EOB-MRI was associated with higher diagnostic accuracy (fewer false-positive and fewer false-negative results). Increasing proportionate use of EOB-MRI resulted in a cost offset per patient (excluding false-negative patients) in both the US (USD 337) and China (CNY 1,443), driven by reductions in scan costs and unnecessary treatment costs. The use of EOB-MRI was also associated with a shorter average waiting time for a final diagnosis and treatment decision for patients compared to MDCT, ECCM-MRI, and CEUS.

Conclusion

The findings of these models demonstrate that EOB-MRI is the most accurate and rapid imaging modality for the diagnosis of HCC in the US and China, resulting in cost offsets that may benefit the healthcare system.

Keywords:

• Hepatocellular carcinoma
• EOB-MRI
• cost offset
• computed tomography
• magnetic resonance imaging
• contrast-enhanced ultrasound

JEL CLASSIFICATION CODES:

• I10
• I1
• I00
• I

Transparency

Declaration of funding

Bayer AG has initiated, organized, and funded this project including payment of agencies involved in the development and execution of this project.

Declaration of financial/other relationships

MB, GK, DZ, and ME are employed by Bayer AG. AC, GJ, and JH are employed by Wickenstones Ltd., the agency involved in the development and execution of this study.

Author contributions

All authors were involved with all aspects of this work (including conception and design; analysis and interpretation of the data and drafting and review of the paper) and agree to be accountable for all aspects of the work.

Acknowledgements

We would like to acknowledge Gemma Zhu who provided vital input to the development of the model in its early stages. We would also like to thank Marie DiFiore and Antonio Remiro-Azócar for their review and input on the project.

Reviewer disclosures

Peer reviewers on this manuscript have received an honorarium from JME for their review work but have no other relevant financial relationships to disclose.