Magnetic resonance imaging is cost-effective for hepatocellular carcinoma surveillance in high-risk patients with cirrhosis
Abstract
Ultrasonography (US) is generally recommended for the surveillance of hepatocellular carcinoma (HCC) in patients at risk. However, in patients with cirrhosis who have sufficiently high HCC incidence, surveillance using magnetic resonance imaging (MRI) with liver-specific contrast showed markedly higher sensitivity in detecting early-stage HCC than US. This study aimed to compare the cost-effectiveness of semiannual surveillance using MRI versus US in patients with compensated cirrhosis and to identify the population that would gain optimal cost-effectiveness through MRI surveillance. We designed a Markov model to compare the expected costs and quality-adjusted life-years (QALYs), between MRI and US, with a 20-year time horizon, from the health care system perspective. The starting age of the cohort was 50 years, and 71% had hepatitis B virus-associated cirrhosis. The cycle length was 6 months. Transition probabilities and costs were obtained mainly from a prospective cohort study (the PRIUS study, NCT01446666). Cost and effectiveness were discounted at 5%. An incremental cost-effectiveness ratio (ICER) was calculated and tested using sensitivity analyses. The cost-effectiveness analysis indicated that the use of MRI incurred $5,562 incremental costs, 0.384 incremental life-years (LYs), and 0.221 incremental QALYs compared to US. The annual HCC incidence was the most influential factor on the ICER. The ICERs were $14,474/LY and $25,202/QALY at an annual HCC incidence of 3%. When the HCC incidence rate was >1.81%, the ICER was below $50,000/QALY. With increased HCC incidence, MRI surveillance was acceptable as a cost-effective option, even with an increased MRI/US cost ratio. Conclusion: Semiannual surveillance using MRI with liver-specific contrast may be more cost-effective than US in patients with virus-associated compensated cirrhosis at sufficiently high HCC risk despite the higher test cost of MRI.
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MRI comes at high financial costs with incremental cost-effectiveness ratios of $14,474/life year and $25,202/quality-adjusted life year at an annual HCC incidence of 3%.
“However, this comes at high fi nancial costs with incremental cost-effectiveness ratios of $14,474/life year and $25,202/ quality-adjusted life year at an annual HCC incidence of 3%. 253”
From EASL-EASD-EASO Clinical Practice Guidelines on the management of metabolic dysfunction-associated steatotic liver disease (MASLD). (2024) · cites this paper as [253]
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“[83] To potentially reduce cost, abbreviated MRI examination protocols with shorter in-scanner time are being tested and have achieved encouraging sensitivities and specificities of 80% – 90% and 91% – 98%, respectively, in small cohort studies.”
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Self-citation
- Authors
- Kim, H., An, J., Park, J., Park, S., Lim, Y., & Lee, E.
- Affiliations
- Sahmyook University (KR)
- Asan Medical Center (KR)
- Sungkyunkwan University (KR)
- Corresponding author
- Kim, Hye‐Lin
- Lim, Young‐Suk
- Venue
- Hepatology
- Published
- 2019-02-25
- Volume
- 69
- Issue
- 4
- Pages
- 1599-1613
- ISSN
- 0270-9139 (ISSN-L)
- 1527-3350
- OpenAlex
- W2898560718
- Cited by
- 114
- References
- 35
- Citations by year
- 2026: 7 · 2025: 17 · 2024: 15 · 2023: 17 · 2022: 12 · 2021: 17 · 2020: 21 · 2019: 8
- FWCI
- 17.51
- Type
- journal article
- Language
- en
- Open access
- closed
- Licence
- Locations
- Hepatology (publishedVersion)
- PubMed (publishedVersion)
- Funders
- National Research Foundation of Korea (2017R1A2B4011233, No. 2017R1A2B4011233)
- Topics
- Social Sciences › Economics, Econometrics and Finance › Economics and Econometrics › Health Systems, Economic Evaluations, Quality of Life
- Health Sciences › Medicine › Hepatology › Hepatocellular Carcinoma Treatment and Prognosis
- Health Sciences › Medicine › Epidemiology › Hepatitis B Virus Studies
- Keywords
- HCC surveillance, magnetic resonance imaging, ultrasonography, liver cirrhosis, cost-effectiveness, hepatitis B virus, quality-adjusted life years, HCC incidence, Markov model, early cancer detection
- MeSH terms
- Adult, Aged, Female, Carcinoma, Hepatocellular, Humans, Liver Cirrhosis, Liver Neoplasms, Magnetic Resonance Imaging, Male, Middle Aged, Population Surveillance
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