OBJECTIVES : Liver metastasis is a common condition in cases of colon cancer. When liver metastasis occurs, patients have a high mortality risk. Patients need to get an early and accurate diagnosis for avoiding this risk. MRI with Gadoxetic-acid(GAX) or extracellular contrast agent(ECCM), or contrast CT(CCT) are used for the diagnosis of liver metastasis in Turkey. The aim of the study was to compare the clinical and economic outcomes of alternative imaging methods in diagnosis of liver metastasis.

METHODS : The clinical and economic differences of GAX, ECCM and CCT were examined through a literature review. An expert opinion survey conducted for the missing data. Data was analyzed using the decision tree model. It is modeled that if the patient didn`t get diagnosed with GAX or ECCM or CCT, then MRI contrast imaging was applied with another agent. In cases which neither GAX nor ECCM were given a diagnosis, then those patients remained undiagnosed. Reimbursement guidelines of Social Security Institution(SSI) were used for cost calculations.

RESULTS : According to the analysis, the diagnosis rate was 99% with GAX, 82% with ECCM and 60% with CCT. The cost of diagnosis per patient with liver metastasis was 280 TL for CT, 229 TL for ECCM and 280 for GAX. However, GAX offered fewer absolute mortality as 92 and 12 compared to CCT and ECCM in a cohort of 1000 patients; because treatment of undiagnosed patients was delayed or missed. GAX avoids 47% and 60% less biopsy need for diagnosis; 14% and 12% less time to diagnosis compared to ECCM and CT, respectively.

CONCLUSIONS : It has been observed that CCT and GAX actually offer similar costs. On the other hand, GAX may reduce the probability of mortality due to misdiagnosis or late diagnosis in patients with liver metastasis by serving the highest diagnosis rate compared to CCT and ECCM.