title: Cost-effectiveness of whole-body bone scans in the pre-liver transplant assessment of patients with hepatocellular carcinoma in Southern Brazil.
abstract: BACKGROUND
  Bone metastases (BM) are rare in patients with early-stage hepatocellular carcinoma (HCC). In many centers, liver transplantation (LTx) policies require patients with HCC to undergo bone scans (BSs).
  
  
  METHODS
  We retrospectively assessed the benefit of BS for patients with a diagnosis of HCC wait-listed for LTx.
  
  
  RESULTS
  BS was performed in 259 of 328 patients (78.9%) and was suggestive of BM in only one (0.4%). At follow-up, 276 patients had received LTx, of whom 207 had undergone BS. Histopathological examination of explants failed to confirm the presence of HCC in 20 patients from the BS group. The survival and recurrence rates of the 187 patients with confirmed HCC in the explant who underwent BS as part of pre-LTx assessment and 69 patients who did not undergo BS were compared. The one- and five-yr post-transplant survival rates were 81% and 69%, respectively, in the BS group vs. 78% and 62%, respectively, in patients who did not undergo BS (p = 0.25). The one- and five-yr post-LTx recurrence rates were 4.8% and 10.7%, respectively, in the BS group vs. 2.9% and 10.1%, respectively, in patients who did not undergo BS (p = 0.46).
  
  
  CONCLUSIONS
  BS generated expenditures of US$39 296 and was not cost-effective.
authors.affiliation: Postgraduate Program in Medicine: Hepatology, School of Medicine, Universidade Federal de Ciências da Saúde de Porto Alegre (UFCSPA), Porto Alegre, RS, Brazil.
authors.forename: Santiago
authors.initials: S
authors.lastname: Rodríguez
authors.affiliation: Postgraduate Program in Economics, Universidade Federal do Rio Grande do Sul (UFRGS), Instituto de Avaliações de Tecnologias e Saúde (IATS), Porto Alegre, RS, Brazil.
authors.forename: Giácomo
authors.initials: G
authors.lastname: Balbinotto Neto
authors.affiliation: Liver Transplantation Group, Santa Casa de Misericórdia de Porto Alegre, Porto Alegre, RS, Brazil.
authors.forename: Guillermo
authors.initials: G
authors.lastname: Kiss
authors.affiliation: Postgraduate Program in Medicine: Hepatology, School of Medicine, Universidade Federal de Ciências da Saúde de Porto Alegre (UFCSPA), Porto Alegre, RS, Brazil.|Liver Transplantation Group, Santa Casa de Misericórdia de Porto Alegre, Porto Alegre, RS, Brazil.
authors.forename: Ajacio
authors.initials: A
authors.lastname: Brandão
mesh_terms: D001938:Brazil; D006528:Carcinoma, Hepatocellular / Q000000981:diagnostic imaging / Q000191:economics* / Q000601:surgery; D003362:Cost-Benefit Analysis; D005260:Female; D005500:Follow-Up Studies; D006801:Humans; D008113:Liver Neoplasms / Q000000981:diagnostic imaging / Q000191:economics* / Q000601:surgery; D016031:Liver Transplantation / Q000191:economics*; D008297:Male; D008875:Middle Aged; D009364:Neoplasm Recurrence, Local / Q000000981:diagnostic imaging / Q000191:economics* / Q000601:surgery; D011300:Preoperative Care; D011379:Prognosis; D012189:Retrospective Studies; D012307:Risk Factors; D051598:Whole Body Imaging / Q000191:economics*
keywords: bone metastases; cost-effectiveness analysis; hepatocellular carcinoma; liver transplantation; radionuclide imaging