Cost of Expensive Imaging Balances Out in Liver Metastases

Pam Harrison

March 10, 2015

VIENNA — For patients with suspected or confirmed liver metastases, the overall cost of upfront gadoxetic-acid-enhanced MRI is similar to that of other imaging strategies when clinical benefits are considered, according to a cost analysis of data from the VALUE study.

The analysis "reinforces the concept of investing in high-quality diagnostics at the beginning of the diagnostic path, rather than troubleshooting at the end, which can cause a lot of additional costs down the line," said Christoph Zech, MD, from the University of Basel in Switzerland.

"The potential clinical benefits shown at similar costs suggest that gadoxetic-acid-enhanced MRI should be the preferred procedure to evaluate hepatic resectability in patients with colorectal cancer liver metastases," Dr Zech told delegates here at the European Congress of Radiology 2015.

Previous results from the VALUE trial — which was conducted in Austria, Germany, Italy, Korea, Spain, Sweden, Switzerland, and Thailand — were published in the British Journal of Surgery (2014;101:613-621).

The 342 patients with suspected colorectal cancer liver metastases were randomly assigned to initial imaging with one of three techniques; 118 underwent gadoxetic-acid-enhanced MRI, 112 underwent extracellular contrast media MRI, and 112 underwent contrast-enhanced CT.

If the initial image was substandard or therapeutic confidence in the imaging was not high enough to proceed to surgery, patients underwent further imaging.

No Additional Imaging Needed

No patients in the gadoxetic acid group required further imaging, whereas 18.1% of the media MRI group and 39.7% of the CT group did; these differences were significant (P < .0001).

And more patients were deemed eligible for surgery after gadoxetic-acid-enhanced MRI than after media MRI or CT (39% vs 31% vs 27%).

In addition, meaningful modifications that increased the duration of surgery were more modest in the gadoxetic acid group than in the media MRI or CT groups (13% vs 16% vs 29%), Dr Zech reported.

The cost of the diagnostic workup using gadoxetic-acid-enhanced MRI — at €423 (US$446) — was actually slightly lower in most of the participating countries than the cost of a workup with media MRI, report Dr Zech and colleagues.

Initial imaging with gadoxetic-acid-enhanced MRI was also less expensive than CT in six of the eight participating countries; in the other two countries, the differences in cost were relatively marginal.

However, the strategy of gadoxetic-acid-enhanced MRI "was more expensive overall because more patients had curative-intended surgery," Dr Zech observed.

The fact that "more patients were able to go to intended surgery" might not seem important from a medical standpoint, but when you are trying to get these agents into clinical practice, it's getting "more and more important" to hospital managers, he said.

Higher Sensitivity

Many studies have found that enhanced MRI has a higher sensitivity than conventional MRI, so this finding is not all that surprising, said study discussant Valerie Vilgrain, MD, from Beaujon Hospital in Clichy, France.

"However, this study goes beyond that; it demonstrated the impact of enhanced MRI on patient management," she said.

In addition, the investigators evaluated not only the cost of the diagnostic workup, but also the cost of planned surgery, unnecessary surgery, and modified surgery, she pointed out.

Dr Vilgrain explained that it is important that all new imaging procedures result in improvements in patient outcomes.

A long-term analysis of the VALUE patients is needed to determine whether there is a difference in concrete end points, such as overall and disease-free survival, with the three imaging strategies, Dr Vilgrain said.

The VALUE study was funded by Bayer HealthCare. Dr Zech reports receiving lecture honoraria and travel costs for educational lectures from Bayer HealthCare. Dr Vilgrain has disclosed no relevant financial relationships.

European Congress of Radiology (ECR) 2015. Presented on March 4, 2015.

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