OBJECTIVES: The main purpose of this study was to conduct an economic evaluation of Primovist enhanced MRI (PV-MRI) compared to extracellular contrast-media-enhanced MRI (ECC-MRI) in patients suffering from liver metastases of colorectal origin in Spain. METHODS: An analytic model previously implemented in three European countries (Germany, Italy and Sweden) was adapted in Spain to estimate all aggregated costs of both diagnosis options compared. Probabilities of needing further imaging and of needing surgical plans modification or confirmation were adjusted by Spanish clinical experts (surgeons and radiologists). Contrasts cost was estimated from PTR (weighting the different EECs prices for sales in Spain for this option), and tests (MRI and CT) and different surgery procedures (high or low risk, modification or confirmation of surgical plans, etc.) costs were extracted from official fees of different Spanish Autonomous Communities (CCAA). RESULTS: PV-MRI was associated with a reduced need for extra imaging tests (6% vs. 9%). Taking into account the costs of diagnosis tests and surgery procedures (including modification of surgical plans during intervention), PV-MRI option was a cost-neutral strategy, with total costs similar to ECC-MRI (576 € vs. € 578, PV-MRI vs ECC-MRI respectively). CONCLUSIONS: Additional costs associated with colorectal liver metastases diagnosis with PV-MRI regarding to ECC-MRI are offset by lower costs in intraoperative changes of the surgical plan and reductions in unnecessary surgery associated with the use of PV-MRI. Results from the previous study VALUE, which showed that no patient with PV required additional imaging tests as part of a Phase IV, confirm the results obtained in the present analysis (resulting in even slightly lower cost than the total cost of diagnosis using PV-MRI).