EVALUATING THE COST-EFFECTIVENESS RESULTS OF DIAGNOSTIC STRATEGIES FOR HEPATOCELLULAR CARCINOMA IN JAPAN
Author(s)
Uchida-Nakakoji M1, Nishie A2, Ball G3, Kruger E4, Crawford B3, Honda H2
1Bayer Yakuhin Ltd., Tokyo, Japan, 2Kyushu University Graduate School of Medical Sciences, Fukuoka, Japan, 3QuintilesIMS, Tokyo, Japan, 4QuintilesIMS, San Francisco, CA, USA
OBJECTIVES: To evaluate cost-effectiveness estimates through model validation and characterization of uncertainty in a cost-effectiveness analysis comparing gadoxetic acid-enhanced magnetic resonance imaging (EOB-MRI) with extracellular contrast-media-enhanced MRI (ECCM-MRI) and contrast-media-enhanced computed tomography (CE-CT) for diagnosis of hepatocellular carcinoma (HCC) in Japan with a focus on local versus foreign inputs. METHODS: Nearly all input parameter values were from local Japanese sources. Model inputs and structure were validated by a Delphi panel of clinical experts. Uncertainty in model inputs was addressed using probabilistic sensitivity analysis. Scenario analyses were also conducted using values derived from previously conducted non-Japanese studies, including diagnostic sensitivity and specificity values reported according to tumor size and utility values used in previous economic evaluations. Probabilistic and sensitivity analyses were conducted based on a 6-stage Markov model constructed to estimate lifetime direct costs and clinical outcomes associated with HCC diagnosis using EOB–MRI, ECCM-MRI and CE-CT. RESULTS: For the per patient probabilistic results for a hypothetical cohort of 100,000 patients over a lifetime horizon, EOB-MRI was associated with lower direct costs (2,363,996 JPY) and generated a greater number of QALYs (10.095) than either ECCM-MRI (2,554,973 JPY, 9.816 QALYs) or CE-CT (2,677,766 JPY, 9.681 QALYs). Under the scenario analysis by tumor size, EOB-MRI was found to be dominant, resulting in a larger incremental difference in costs than was found in the base case versus other diagnostic strategies. In the scenario analysis for the utility values, EOB-MRI remained dominant despite smaller incremental differences compared to the base case. CONCLUSIONS: Both probabilistic and scenario based results closely matched the base case results, providing preliminary validation of the model and supporting the finding that EOB-MRI is a cost-effective option over ECCM-MRI and CE-CT.
Conference/Value in Health Info
2017-05, ISPOR 2017, Boston, MA, USA
Value in Health, Vol. 20, No. 5 (May 2017)
Code
PMD53
Topic
Economic Evaluation
Topic Subcategory
Cost-comparison, Effectiveness, Utility, Benefit Analysis
Disease
Oncology