title: Cost-effectiveness of EOB-MRI for Hepatocellular Carcinoma in Japan.
abstract: OBJECTIVE
  The objective of the study was to evaluate the cost-effectiveness of gadoxetic acid-enhanced magnetic resonance imaging (EOB-MRI) in the diagnosis and treatment of hepatocellular carcinoma (HCC) in Japan compared with extracellular contrast media-enhanced MRI (ECCM-MRI) and contrast media-enhanced computed tomography (CE-CT) scanning.
  
  
  METHODS
  A 6-stage Markov model was developed to estimate lifetime direct costs and clinical outcomes associated with EOB-MRI. Diagnostic sensitivity and specificity, along with clinical data on HCC survival, recurrence, treatment patterns, costs, and health state utility values, were derived from predominantly Japanese publications. Parameters unavailable from publications were estimated in a Delphi panel of Japanese clinical experts who also confirmed the structure and overall approach of the model. Sensitivity analyses, including one-way, probabilistic, and scenario analyses, were conducted to account for uncertainty in the results.
  
  
  RESULTS
  Over a lifetime horizon, EOB-MRI was associated with lower direct costs (¥2,174,869) and generated a greater number of quality-adjusted life years (QALYs) (9.502) than either ECCM-MRI (¥2,365,421, 9.303 QALYs) or CE-CT (¥2,482,608, 9.215 QALYs). EOB-MRI was superior to the other diagnostic strategies considered, and this finding was robust over sensitivity and scenario analyses. A majority of the direct costs associated with HCC in Japan were found to be costs of treatment. The model results revealed the superior cost-effectiveness of the EOB-MRI diagnostic strategy compared with ECCM-MRI and CE-CT.
  
  
  CONCLUSIONS
  EOB-MRI could be the first-choice imaging modality for medical care of HCC among patients with hepatitis or liver cirrhosis in Japan. Widespread implementation of EOB-MRI could reduce health care expenditures, particularly downstream treatment costs, associated with HCC.
authors.affiliation: Kyushu University, Fukuoka, Japan. Electronic address: anishie@radiol.med.kyushu-u.ac.jp.
authors.forename: Akihiro
authors.initials: A
authors.lastname: Nishie
authors.affiliation: Gifu University Hospital, Gifu, Japan.
authors.forename: Satoshi
authors.initials: S
authors.lastname: Goshima
authors.affiliation: Nihon University Hospital, Tokyo, Japan.
authors.forename: Hiroki
authors.initials: H
authors.lastname: Haradome
authors.affiliation: Hyogo University Hospital, Hyogo, Japan.
authors.forename: Etsuro
authors.initials: E
authors.lastname: Hatano
authors.affiliation: Ikeda Municipal Hospital, Osaka, Japan.
authors.forename: Yasuharu
authors.initials: Y
authors.lastname: Imai
authors.affiliation: Kindai University Hospital, Osaka, Japan.
authors.forename: Masatoshi
authors.initials: M
authors.lastname: Kudo
authors.affiliation: Yamanashi University, Yamanashi, Japan.
authors.forename: Masanori
authors.initials: M
authors.lastname: Matsuda
authors.affiliation: Yamanashi University, Yamanashi, Japan.
authors.forename: Utaroh
authors.initials: U
authors.lastname: Motosugi
authors.affiliation: Toranomon Hospital, Tokyo, Japan.
authors.forename: Satoshi
authors.initials: S
authors.lastname: Saitoh
authors.affiliation: Fukuoka University Hospital, Fukuoka, Japan.
authors.forename: Kengo
authors.initials: K
authors.lastname: Yoshimitsu
authors.affiliation: QuintilesIMS, Tokyo, Japan.
authors.forename: Bruce
authors.initials: B
authors.lastname: Crawford
authors.affiliation: QuintilesIMS, Tokyo, Japan.
authors.forename: Eliza
authors.initials: E
authors.lastname: Kruger
authors.affiliation: QuintilesIMS, Tokyo, Japan.
authors.forename: Graeme
authors.initials: G
authors.lastname: Ball
authors.affiliation: Kyushu University, Fukuoka, Japan.
authors.forename: Hiroshi
authors.initials: H
authors.lastname: Honda
mesh_terms: D006528:Carcinoma, Hepatocellular / Q000000981:diagnostic imaging* / Q000191:economics*; D003287:Contrast Media; D003362:Cost-Benefit Analysis; D019786:Gadolinium DTPA; D006801:Humans; D007564:Japan; D008113:Liver Neoplasms / Q000000981:diagnostic imaging* / Q000191:economics*; D008279:Magnetic Resonance Imaging / Q000191:economics* / Q000379:methods*; D019057:Quality-Adjusted Life Years; D014057:Tomography, X-Ray Computed / Q000379:methods
chemical_list: D003287:Contrast Media; C073590:gadolinium ethoxybenzyl DTPA; D019786:Gadolinium DTPA
keywords: CT; MRI; cost; economic evaluation; gadoxetic acid; hepatocellular carcinoma; liver imaging