PDF(Pubmed)
Abstract：
OBJECTIVE: Reinforced hepatocellular carcinoma (HCC) surveillance using magnetic resonance imaging (MRI) could increase early tumour detection but faces cost-effectiveness issues. In this study, we aimed to evaluate the cost-effectiveness of MRI for the detection of very early HCC (Barcelona Clinic Liver Cancer [BCLC] 0) in patients with an annual HCC risk >3%.
METHODS: French patients with compensated cirrhosis included in 4 multicentre prospective cohorts were considered. A scoring system was constructed to identify patients with an annual risk >3%. Using a Markov model, the economic evaluation estimated the costs and life years (LYs) gained with MRI vs. ultrasound (US) monitoring over a 20-year period. The incremental cost-effectiveness ratio (ICER) was calculated by dividing the incremental costs by the incremental LYs.
RESULTS: Among 2,513 patients with non-viral causes of cirrhosis (n = 840) and/or cured HCV (n = 1,489)/controlled HBV infection (n = 184), 206 cases of HCC were detected after a 37-month follow-up. When applied to training (n = 1,658) and validation (n = 855) sets, the construction of a scoring system identified 33.4% and 37.5% of patients with an annual HCC risk >3% (3-year C-Indexes 75 and 76, respectively). In patients with a 3% annual risk, the incremental LY gained with MRI was 0.4 for an additional cost of €6,134, resulting in an ICER of €15,447 per LY. Compared to US monitoring, MRI detected 5x more BCLC 0 HCC. The deterministic sensitivity analysis confirmed the impact of HCC incidence. At a willingness to pay of €50,000/LY, MRI screening had a 100% probability of being cost-effective.
CONCLUSIONS: In the era of HCV eradication/HBV control, patients with annual HCC risk >3% represent one-third of French patients with cirrhosis. MRI is cost-effective in this population and could favour early HCC detection.
BACKGROUND: The early identification of hepatocellular carcinoma in patients with cirrhosis is important to improve patient outcomes. Magnetic resonance imaging could increase early tumour detection but is more expensive and less accessible than ultrasound (the standard modality for surveillance). Herein, using a simple score, we identified a subgroup of patients with cirrhosis (accounting for >one-third), who were at increased risk of hepatocellular carcinoma and for whom the increased expense of magnetic resonance imaging would be justified by the potential improvement in outcomes.
METHODS: French patients with compensated cirrhosis included in 4 multicentre prospective cohorts were considered. A scoring system was constructed to identify patients with an annual risk >3%. Using a Markov model, the economic evaluation estimated the costs and life years (LYs) gained with MRI vs. ultrasound (US) monitoring over a 20-year period. The incremental cost-effectiveness ratio (ICER) was calculated by dividing the incremental costs by the incremental LYs.
RESULTS: Among 2,513 patients with non-viral causes of cirrhosis (n = 840) and/or cured HCV (n = 1,489)/controlled HBV infection (n = 184), 206 cases of HCC were detected after a 37-month follow-up. When applied to training (n = 1,658) and validation (n = 855) sets, the construction of a scoring system identified 33.4% and 37.5% of patients with an annual HCC risk >3% (3-year C-Indexes 75 and 76, respectively). In patients with a 3% annual risk, the incremental LY gained with MRI was 0.4 for an additional cost of €6,134, resulting in an ICER of €15,447 per LY. Compared to US monitoring, MRI detected 5x more BCLC 0 HCC. The deterministic sensitivity analysis confirmed the impact of HCC incidence. At a willingness to pay of €50,000/LY, MRI screening had a 100% probability of being cost-effective.
CONCLUSIONS: In the era of HCV eradication/HBV control, patients with annual HCC risk >3% represent one-third of French patients with cirrhosis. MRI is cost-effective in this population and could favour early HCC detection.
BACKGROUND: The early identification of hepatocellular carcinoma in patients with cirrhosis is important to improve patient outcomes. Magnetic resonance imaging could increase early tumour detection but is more expensive and less accessible than ultrasound (the standard modality for surveillance). Herein, using a simple score, we identified a subgroup of patients with cirrhosis (accounting for >one-third), who were at increased risk of hepatocellular carcinoma and for whom the increased expense of magnetic resonance imaging would be justified by the potential improvement in outcomes.
摘要：
目的：使用磁共振成像（MRI）加强肝细胞癌（HCC）监测可以增加早期肿瘤检测，但面临成本效益问题。在这项研究中,我们的目的是评估MRI检测非常早期HCC(巴塞罗那诊所肝癌[BCLC]0)的成本效益,用于每年HCC风险>3%的患者.
方法：法国代偿期肝硬化患者纳入4个多中心前瞻性队列。构建了一个评分系统来识别年风险>3%的患者。使用马尔可夫模型，经济评估估计了MRI获得的成本和寿命年(LYs)与超声（美国）监测超过20年。增量成本效益比(ICER)是通过将增量成本除以增量LY来计算的。
结果：在2,513例非病毒原因的肝硬化（n=840）和/或治愈的HCV（n=1,489）/控制的HBV感染（n=184），经37个月随访,共检出HCC206例。当应用于训练(n=1,658)和验证(n=855)集时，评分系统的构建确定了33.4%和37.5%的患者每年HCC风险>3%(3年C指数分别为75和76).每年有3%风险的患者，MRI的LY增量为0.4,额外费用为6,134欧元,每LY的ICER为15,447欧元.与美国监测相比，MRI检出5x以上的BCLC0肝癌。确定性敏感性分析证实了HCC发病率的影响。在愿意支付50,000欧元/LY的情况下，MRI筛查具有100％的成本效益的可能性。
结论：在HCV根除/HBV控制的时代，每年HCC风险>3%的患者占法国肝硬化患者的三分之一.MRI在该人群中具有成本效益，并且可能有利于早期HCC检测。
背景：早期识别肝硬化患者的肝细胞癌对于改善患者预后很重要。磁共振成像可以增加早期肿瘤检测，但比超声（标准监测方式）更昂贵且更不易获得。在这里，用一个简单的分数，我们确定了肝硬化患者的亚组（占>三分之一），这些患者患肝细胞癌的风险增加,磁共振成像的费用增加,其结局的潜在改善是合理的.
方法：法国代偿期肝硬化患者纳入4个多中心前瞻性队列。构建了一个评分系统来识别年风险>3%的患者。使用马尔可夫模型，经济评估估计了MRI获得的成本和寿命年(LYs)与超声（美国）监测超过20年。增量成本效益比(ICER)是通过将增量成本除以增量LY来计算的。
结果：在2,513例非病毒原因的肝硬化（n=840）和/或治愈的HCV（n=1,489）/控制的HBV感染（n=184），经37个月随访,共检出HCC206例。当应用于训练(n=1,658)和验证(n=855)集时，评分系统的构建确定了33.4%和37.5%的患者每年HCC风险>3%(3年C指数分别为75和76).每年有3%风险的患者，MRI的LY增量为0.4,额外费用为6,134欧元,每LY的ICER为15,447欧元.与美国监测相比，MRI检出5x以上的BCLC0肝癌。确定性敏感性分析证实了HCC发病率的影响。在愿意支付50,000欧元/LY的情况下，MRI筛查具有100％的成本效益的可能性。
结论：在HCV根除/HBV控制的时代，每年HCC风险>3%的患者占法国肝硬化患者的三分之一.MRI在该人群中具有成本效益，并且可能有利于早期HCC检测。
背景：早期识别肝硬化患者的肝细胞癌对于改善患者预后很重要。磁共振成像可以增加早期肿瘤检测，但比超声（标准监测方式）更昂贵且更不易获得。在这里，用一个简单的分数，我们确定了肝硬化患者的亚组（占>三分之一），这些患者患肝细胞癌的风险增加,磁共振成像的费用增加,其结局的潜在改善是合理的.
