title: Cost evaluation of gadoxetic acid-enhanced magnetic resonance imaging in the diagnosis of colorectal-cancer metastasis in the liver: Results from the VALUE Trial.
abstract: OBJECTIVE
  To assess the costs of diagnostic workup and surgery of three strategies for patients with colorectal cancer liver-metastases (CRCLM): gadoxetic-acid-enhanced MRI (Gd-EOB-DTPA-MRI), MRI with extracellular contrast-media (ECCM-MRI) or contrast-enhanced MDCT (CE-MDCT).
  
  
  METHODS
  The within-trial cost evaluation was modelled as a decision-tree to calculate the cost of diagnosis and surgery. The model used clinical outcomes and resource utilization data from a prospective randomized multicentre study. Analyses were performed for the 354-patient safety population from eight participating countries.
  
  
  RESULTS
  The diagnostic workup cost using Gd-EOB-DTPA-MRI upfront resulted in savings compared to ECCM-MRI in all countries except Thailand (difference <2 %). Compared to CE-MDCT, initial imaging with Gd-EOB-DTPA-MRI was less costly in all countries except Korea and Spain (differences 4 and 8 %, respectively). Significantly more patients in the Gd-EOB-DTPA-MRI group were eligible for surgery (39.3 % (48/122) vs. 31.0 % (36/116) and 26.7 % (31/116) for ECCM-MRI and CE-MDCT, respectively), allowing more patients to undergo potentially curative surgery, but resulting in higher treatment costs for the strategy starting with Gd-EOB-DTPA-MRI.
  
  
  CONCLUSIONS
  The benefits of Gd-EOB-DTPA-MRI due to less additional imaging and similar diagnostic workup costs in the three groups suggest that Gd-EOB-DTPA-MRI should be the preferred initial imaging procedure to evaluate hepatic resectability in patients with CRCLM.
  
  
  CONCLUSIONS
  • Diagnostic imaging cost to evaluate resectability was similar among the groups • Cost for imaging was rather small compared to the cost of surgery • Significantly more patients in the Gd-EOB-DTPA-MRI arm were eligible for surgery • Gd-EOB-DTPA-MRI is recommended for evaluating hepatic resectability in patients with CRCLM.
authors.affiliation: Clinic of Radiology und Nuclear Medicine, University Hospital Basel, Petersgraben 4, CH-4031, Basel, Switzerland. Christoph.Zech@usb.ch.
authors.forename: Christoph J
authors.initials: CJ
authors.lastname: Zech
authors.affiliation: Life Sciences, OptumInsight, Stockholm, Sweden.
authors.forename: Nahila
authors.initials: N
authors.lastname: Justo
authors.affiliation: Life Sciences, OptumInsight, Stockholm, Sweden.
authors.forename: Andrea
authors.initials: A
authors.lastname: Lang
authors.affiliation: Department of Radiology, General Hospital of Vienna (AKH), Medical University of Vienna, Vienna, Austria.
authors.forename: Ahmed
authors.initials: A
authors.lastname: Ba-Ssalamah
authors.affiliation: Severance Hospital, Yonsei University, Seoul, South Korea.
authors.forename: Myeong-Jin
authors.initials: MJ
authors.lastname: Kim
authors.affiliation: BioBridge Strategies, Binningen, Switzerland.
authors.forename: Harald
authors.initials: H
authors.lastname: Rinde
authors.affiliation: Department of Upper Abdominal Surgery, Karolinska University Hospital, Stockholm, Sweden.
authors.forename: Eduard
authors.initials: E
authors.lastname: Jonas
mesh_terms: D000368:Aged; D015179:Colorectal Neoplasms / Q000191:economics*; D003287:Contrast Media / Q000191:economics*; D003362:Cost-Benefit Analysis; D005260:Female; D019786:Gadolinium DTPA / Q000191:economics*; D006801:Humans; D008113:Liver Neoplasms / Q000175:diagnosis* / Q000191:economics / Q000556:secondary; D008279:Magnetic Resonance Imaging / Q000191:economics / Q000379:methods; D008297:Male; D008875:Middle Aged; D011446:Prospective Studies
chemical_list: D003287:Contrast Media; C073590:gadolinium ethoxybenzyl DTPA; D019786:Gadolinium DTPA
keywords: Contrast agents; Cost; Economic evaluation; Liver imaging; Magnetic resonance imaging