title: Health economic evaluation of Gd-EOB-DTPA MRI vs ECCM-MRI and multi-detector computed tomography in patients with suspected hepatocellular carcinoma in Thailand and South Korea.
abstract: OBJECTIVE
  The effectiveness of treatment decisions and economic outcomes of using gadolinium ethoxybenzyl diethylenetriamine pentaacetic acid-enhanced magnetic resonance imaging (Gd-EOB-DTPA-MRI) were compared with extracellular contrast media-enhanced MRI (ECCM-MRI) and multi-detector computed tomography (MDCT) as initial procedures in patients with suspected hepatocellular carcinoma (HCC) in South Korea and Thailand.
  
  
  METHODS
  A decision-tree model simulated the clinical pathway for patients with suspected HCC from the first imaging procedure to a confirmed treatment decision. Input data (probabilities and resource consumptions) were estimated and validated by clinical experts. Costs for diagnostic alternatives and related treatment options were derived from published sources, taking into account both payer's and hospital's perspectives.
  
  
  RESULTS
  All experts from Korea and Thailand agreed that Gd-EOB-DTPA-MRI yields the highest diagnostic certainty and minimizes the need for additional confirmatory diagnostic procedures in HCC. In Korea, from the payer's perspective, total cost was USD $3087/patient to reach a confirmed treatment decision using Gd-EOB-DTPA-MRI (vs $3205/patient for MDCT and $3403/patient for ECCM-MRI). From the hospital's perspective, Gd-EOB-DTPA-MRI incurred the lowest cost ($2289/patient vs $2320/patient and $2528/patient, respectively). In Thailand, Gd-EOB-DTPA-MRI was the least costly alternative for the payer ($702/patient vs $931/patient for MDCT and $873/patient for ECCM-MRI). From the hospital's perspective, costs were $1106/patient, $1178/patient, and $1087/patient for Gd-EOB-DTPA-MRI, MDCT, and ECCM-MRI, respectively.
  
  
  CONCLUSIONS
  Gd-EOB-DTPA-MRI as an initial imaging procedure in patients with suspected HCC provides better diagnostic certainty and relevant statutory health insurance cost savings in Thailand and Korea, compared with ECCM-MRI and MDCT.
authors.affiliation: a Department of Radiology , Seoul National University College of Medicine and Institute of Radiation Medicine , Seoul , Korea ;
authors.forename: Jeong-Min
authors.initials: JM
authors.lastname: Lee
authors.affiliation: b Department of Radiology , Research Institute of Radiological Science, Severance Hospital, Yonsei University College of Medicine , Seoul , South Korea ;
authors.forename: Myeong-Jin
authors.initials: MJ
authors.lastname: Kim
authors.affiliation: c Department of Radiology, Faculty of Medicine, Ramathibodi Hospital , Mahidol University , Bangkok , Thailand ;
authors.forename: Sith
authors.initials: S
authors.lastname: Phongkitkarun
authors.affiliation: d Department of Medicine, Faculty of Medicine , Ramathibodi Hospital, Mahidol University , Bangkok , Thailand ;
authors.forename: Abhasnee
authors.initials: A
authors.lastname: Sobhonslidsuk
authors.affiliation: e Health Outcomes Strategies LLC , Basel , Switzerland ;
authors.forename: Anke-Peggy
authors.initials: AP
authors.lastname: Holtorf
authors.affiliation: e Health Outcomes Strategies LLC , Basel , Switzerland ;
authors.forename: Harald
authors.initials: H
authors.lastname: Rinde
authors.affiliation: f Clinical Supply Management , Bayer Pharma AG , Berlin , Germany.
authors.forename: Karsten
authors.initials: K
authors.lastname: Bergmann
mesh_terms: D006528:Carcinoma, Hepatocellular / Q000000981:diagnostic imaging* / Q000473:pathology; D003198:Computer Simulation; D003287:Contrast Media; D003362:Cost-Benefit Analysis; D003661:Decision Support Techniques; D003697:Delphi Technique; D005260:Female; D019786:Gadolinium DTPA; D006801:Humans; D008113:Liver Neoplasms / Q000000981:diagnostic imaging* / Q000473:pathology; D008279:Magnetic Resonance Imaging / Q000191:economics* / Q000379:methods; D008297:Male; D008875:Middle Aged; D017059:Models, Econometric; D056910:Republic of Korea; D012680:Sensitivity and Specificity; D013785:Thailand; D014057:Tomography, X-Ray Computed / Q000191:economics* / Q000379:methods
chemical_list: D003287:Contrast Media; C073590:gadolinium ethoxybenzyl DTPA; D019786:Gadolinium DTPA
keywords: Computed tomography; Cost analysis; Gd-EOB-DTPA-MRI; Hepatocellular carcinoma; Magnetic resonance imaging