title: Health-economic evaluation of three imaging strategies in patients with suspected colorectal liver metastases: Gd-EOB-DTPA-enhanced MRI vs. extracellular contrast media-enhanced MRI and 3-phase MDCT in Germany, Italy and Sweden.
abstract: The purpose of this study was to perform an economic evaluation of hepatocyte-specific Gd-EOB-DTPA enhanced MRI (PV-MRI) compared to extracellular contrast-media-enhanced MRI (ECCM-MRI) and three-phase-MDCT as initial modalities in the work-up of patients with metachronous colorectal liver metastases. The economic evaluation was performed with a decision-tree model designed to estimate all aggregated costs depending on the initial investigation. Probabilities on the need for further imaging to come to a treatment decision were collected through interviews with 13 pairs of each a radiologist and a liver surgeon in Germany, Italy and Sweden. The rate of further imaging needed was 8.6% after initial PV-MRI, 18.5% after ECCM-MRI and 23.5% after MDCT. Considering the cost of all diagnostic work-up, intra-operative treatment changes and unnecessary surgery, a strategy starting with PV-MRI with 959 Euro was cost-saving compared to ECCM-MRI (1,123 Euro) and MDCT (1,044 Euro) in Sweden. In Italy and Germany, PV-MRI was cost-saving compared to ECCM-MRI and had total costs similar to MDCT. In conclusion, our results indicate that PV-MRI can lead to cost savings by improving pre-operative planning and decreasing intra-operative changes. The higher cost of imaging with PV-MRI is offset in such a scenario by lower costs for additional imaging and less intra-operative changes.
authors.affiliation: Institute of Clinical Radiology, University Hospital Munich-Grosshadern, Munich, Germany. Christoph.Zech@med.uni-muenchen.de
authors.forename: C J
authors.initials: CJ
authors.lastname: Zech
authors.forename: L
authors.initials: L
authors.lastname: Grazioli
authors.forename: E
authors.initials: E
authors.lastname: Jonas
authors.forename: M
authors.initials: M
authors.lastname: Ekman
authors.forename: R
authors.initials: R
authors.lastname: Niebecker
authors.forename: S
authors.initials: S
authors.lastname: Gschwend
authors.forename: J
authors.initials: J
authors.lastname: Breuer
authors.forename: L
authors.initials: L
authors.lastname: Jönsson
authors.forename: S
authors.initials: S
authors.lastname: Kienbaum
mesh_terms: D015179:Colorectal Neoplasms / Q000175:diagnosis* / Q000191:economics* / Q000453:epidemiology; D003287:Contrast Media / Q000191:economics; D019786:Gadolinium DTPA / Q000191:economics*; D005858:Germany / Q000453:epidemiology; D017048:Health Care Costs / Q000706:statistics & numerical data*; D006801:Humans; D007558:Italy / Q000453:epidemiology; D008113:Liver Neoplasms / Q000175:diagnosis / Q000191:economics / Q000453:epidemiology / Q000556:secondary; D008279:Magnetic Resonance Imaging / Q000191:economics* / Q000706:statistics & numerical data; D013548:Sweden / Q000453:epidemiology; D014057:Tomography, X-Ray Computed / Q000706:statistics & numerical data*
chemical_list: D003287:Contrast Media; C073590:gadolinium ethoxybenzyl DTPA; C064925:gadodiamide; D019786:Gadolinium DTPA