OBJECTIVES: Hepatocellular cancer (HCC) is the most common type of primary liver cancer; in addition, the liver is the most frequent site of metastatic disease for colorectal cancer. This study compared costs of diagnosis and treatment of HCC (primary liver cancer) and colorectal cancer liver metastasis (CRCLM; secondary liver cancer) in a UK setting, according to initial diagnostic imaging modality selection.

METHODS: Modalities assessed included: gadoxetate disodium (ethoxylbenzyl-diethylenetriaminepentaacetic acid)-enhanced magnetic resonance imaging (EOB-MRI), extracellular contrast media enhanced-MRI (ECCM-MRI), multidetector computed tomography (MDCT) and contrast-enhanced ultrasound (CEUS). Individual decision tree models were developed to simulate the clinical pathway for HCC and CRCLM, from first diagnostic test to initial treatment decision, based on local clinical guidelines and validated by experts. Input values were derived from the literature as well as from interviews with local experts.

RESULTS: Comparisons between the modalities demonstrated that initial selection of EOB-MRI delivered cost savings per patient versus alternative options. This result was consistent across HCC and CRCLM. Cost offsets with EOB-MRI were driven by a reduced requirement for follow-on procedures, both in terms of diagnosis and therapy, leading to reductions in costs related to contrast agents, scans, biopsies, and unnecessary treatments. Budget impact scenarios, where the proportionate use of different initial imaging modalities was varied, showed that increasing use of EOB-MRI was consistently associated with lowered costs.

CONCLUSIONS: These findings demonstrate that, in the UK setting, initial selection of EOB-MRI in the diagnosis of primary and secondary liver cancers results in cost savings compared to other available options.