Christoph Johannes Zech MD, Presenter: Nothing to Disclose

Luigi Grazioli MD, Abstract Co-Author: Research grant, Bracco Group

Eduard Jonas MD, Abstract Co-Author: Nothing to Disclose

Mattias Ekman PhD, Abstract Co-Author: Employee, UnitedHealth Group

Ronald Niebecker, Abstract Co-Author: Former employee, Bayer AG

Simone Gschwend MD, PhD, Abstract Co-Author: Employee, Bayer AG

Josy Breuer MD, Abstract Co-Author: Employee, Bayer AG

Linus Jönsson, Abstract Co-Author: Employee, UnitedHealth Group, Stockholm, Sweden

Amy Guo PhD, Abstract Co-Author: Research funded, Bayer AG Employee, Bayer AG

Susanne Kienbaum PhD, Abstract Co-Author: Former employee, Bayer AG

et al, Abstract Co-Author: Nothing to Disclose

To perform an economic evaluation of Gd-EOB-DTPA (Primovist, Bayer Healthcare)-enhanced MRI (PV-MRI) compared to MRI with extracellular contrast-media (ECCM-MRI) and 3-phase MDCT (MDCT) as initial diagnostic modalities in the work-up of patients with known or suspected metachronous colorectal liver metastases.

The economic evaluation was performed with a decision-tree model designed to estimate all aggregated costs for diagnostic imaging and modified surgical procedures depending on the initial diagnostic strategy. Probabilities on the need for further imaging and subsequent surgical planning were collected through interviews with 13 pairs of each a radiologist and a liver surgeon in Germany, Italy, and Sweden.

The evaluation revealed that the rate of further imaging needed was 8.6% after initial PV-MRI, 18.5% after ECCM-MRI, and 23.5% after MDCT leading to lower additional cost for diagnostic work-up when PV-MRI was used for initial imaging. Moreover, the rate of confirmed findings at surgery was with 81.4% highest if PV-MRI was used as the first imaging modality compared to MDCT and ECCM-MRI (74.8% and 74.3%, respectively), and the rate of unnecessary surgery was with 5.7% lowest for PV-MRI compared to 8.3% and 8.6% for MDCT and ECCM-MRI, respectively. Considering all diagnostic work-up, intra-operative treatment changes and the cost of unnecessary surgery, a strategy starting with PV-MRI was with 959€ cost-saving compared to ECCM-MRI (1123€) and MDCT (1044€) in Sweden. In Italy and Germany, PV-MRI was cost-saving compared to ECCM-MRI and had similar total costs compared to MDCT.

The results indicate that PV-MRI leads to cost-savings by improving pre-operative planning and decreasing intra-operative treatment changes. Even if the cost of initial imaging is higher for PV-MRI than for MDCT and ECCM-MRI, lower costs for additional imaging and less changes in pre-operative planning lead to lower total cost for PV-MRI compared to ECCM-MRI and at least similar cost compared to MDCT.  

The data derived from this model show that Primovist-enhanced MRI is a cost-saving method for the workup of patients with suspected colorectal liver metastases despite higher initial cost for imaging.

Zech, C, Grazioli, L, Jonas, E, Ekman, M, Niebecker, R, Gschwend, S, Breuer, J, Jönsson, L, Guo, A, Kienbaum, S, et al, , Health Economic Evaluation of Three Imaging Strategies in Patients with Suspected Colorectal Liver Metastases: Primovist-enhanced MRI versus Extracellular Contrast Media-enhanced MRI and 3-phase MDCT in Germany, Italy and Sweden.  Radiological Society of North America 2008 Scientific Assembly and Annual Meeting, February 18 - February 20, 2008 ,Chicago IL. http://archive.rsna.org/2008/6012714.html