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01-01-2018 | Health Economy

A cost-effectiveness analysis of the diagnostic strategies for differentiating focal nodular hyperplasia from hepatocellular adenoma

Authors: Chong Hyun Suh, Kyung Won Kim, Seong Ho Park, Sangjin Shin, Jeonghoon Ahn, Junhee Pyo, Atul B. Shinagare, Katherine M. Krajewski, Nikhil H. Ramaiya

Published in: European Radiology | Issue 1/2018

Abstract

Objectives

We evaluated the cost-effectiveness of a gadoxetic acid-enhanced MRI (EOB-MRI) strategy compared with conventional MRI strategy and biopsy to differentiate focal nodular hyperplasia (FNH) from hepatocellular adenoma (HCA).

Methods

A decision tree model was constructed to compare the cost-effectiveness of EOB-MRI, conventional MRI with extracellular contrast agents, and biopsy as the initial diagnostic modality in patients with incidentally detected focal liver lesions suspected of being FNH or HCA. We analysed the cost and effectiveness, i.e. probability of successful diagnosis of each strategy. Costs were based on utilisation rates and Medicare reimbursements in the USA and South Korea.

Results

In the base case analysis of our decision tree model, the effectiveness of the three strategies was similar. The cost of the EOB-MRI strategy ($1283 in USA, $813 in South Korea) was lowest compared with the biopsy strategy ($1725 in USA, $847 in South Korea) and the conventional MRI strategy ($1750 in USA, $962 in South Korea). One-way, two-way and probabilistic sensitivity analysis showed unchanged results over an acceptable range.

Conclusions

EOB-MRI strategy is the most cost-effective strategy for differentiating FNH from HCA in patients with incidentally detected focal liver lesions in a non-cirrhotic liver.

Key points

• The effectiveness of the three strategies was similar.

• The cost of the EOB-MRI strategy was lowest.

• EOB-MRI strategy is the most cost-effective for differentiating FNH from HCA.

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Khosa F, Khan AN, Eisenberg RL (2011) Hypervascular liver lesions on MRI. AJR Am J Roentgenol 197:W204–W220CrossRefPubMed

Bartolotta TV, Taibbi A, Midiri M, Matranga D, Solbiati L, Lagalla R (2011) Indeterminate focal liver lesions incidentally discovered at gray-scale US: role of contrast-enhanced sonography. Invest Radiol 46:106–115CrossRefPubMed

Westwood M, Joore M, Grutters J et al (2013) Contrast-enhanced ultrasound using SonoVue® (sulphur hexafluoride microbubbles) compared with contrast-enhanced computed tomography and contrast-enhanced magnetic resonance imaging for the characterisation of focal liver lesions and detection of liver metastases: a systematic review and cost-effectiveness analysis. Health Technol Assess 17:1–243CrossRef

Marrero JA, Ahn J, Rajender Reddy K (2014) ACG clinical guideline: the diagnosis and management of focal liver lesions. Am J Gastroenterol 109:1328–1347CrossRefPubMed

De Carlis L, Pirotta V, Rondinara GF et al (1997) Hepatic adenoma and focal nodular hyperplasia: diagnosis and criteria for treatment. Liver Transpl Surg 3:160–165CrossRefPubMed

Herman P, Pugliese V, Machado MA et al (2000) Hepatic adenoma and focal nodular hyperplasia: differential diagnosis and treatment. World J Surg 24:372–376CrossRefPubMed

Leese T, Farges O, Bismuth H (1988) Liver cell adenomas. A 12-year surgical experience from a specialist hepato-biliary unit. Ann Surg 208:558–564CrossRefPubMedPubMedCentral

Bertin C, Egels S, Wagner M, Huynh-Charlier I, Vilgrain V, Lucidarme O (2014) Contrast-enhanced ultrasound of focal nodular hyperplasia: a matter of size. Eur Radiol 24:2561–2571CrossRefPubMed

Bieze M, van den Esschert JW, Nio CY et al (2012) Diagnostic accuracy of MRI in differentiating hepatocellular adenoma from focal nodular hyperplasia: prospective study of the additional value of gadoxetate disodium. AJR Am J Roentgenol 199:26–34CrossRefPubMed

10.

Grazioli L, Bondioni MP, Haradome H et al (2012) Hepatocellular adenoma and focal nodular hyperplasia: value of gadoxetic acid-enhanced MR imaging in differential diagnosis. Radiology 262:520–529CrossRefPubMed

11.

Gupta RT, Iseman CM, Leyendecker JR, Shyknevsky I, Merkle EM, Taouli B (2012) Diagnosis of focal nodular hyperplasia with MRI: multicenter retrospective study comparing gadobenate dimeglumine to gadoxetate disodium. AJR Am J Roentgenol 199:35–43CrossRefPubMed

12.

Purysko AS, Remer EM, Coppa CP, Obuchowski NA, Schneider E, Veniero JC (2012) Characteristics and distinguishing features of hepatocellular adenoma and focal nodular hyperplasia on gadoxetate disodium-enhanced MRI. AJR Am J Roentgenol 198:115–123CrossRefPubMed

13.

Neri E, Bali MA, Ba-Ssalamah A et al (2016) ESGAR consensus statement on liver MR imaging and clinical use of liver-specific contrast agents. Eur Radiol 26:921–931CrossRefPubMed

14.

Merkle EM, Zech CJ, Bartolozzi C et al (2016) Consensus report from the 7th International Forum for Liver Magnetic Resonance Imaging. Eur Radiol 26:674–682CrossRefPubMed

15.

Bioulac-Sage P, Balabaud C, Bedossa P et al (2007) Pathological diagnosis of liver cell adenoma and focal nodular hyperplasia: Bordeaux update. J Hepatol 46:521–527CrossRefPubMed

16.

Grazioli L, Morana G, Federle MP et al (2001) Focal nodular hyperplasia: morphologic and functional information from MR imaging with gadobenate dimeglumine. Radiology 221:731–739CrossRefPubMed

17.

Cherqui D, Rahmouni A, Charlotte F et al (1995) Management of focal nodular hyperplasia and hepatocellular adenoma in young women: a series of 41 patients with clinical, radiological, and pathological correlations. Hepatology 22:1674–1681CrossRefPubMed

18.

Okigawa T, Utsunomiya D, Tajiri S et al (2014) Incidence and severity of acute adverse reactions to four different gadolinium-based MR contrast agents. Magn Reson Med Sci 13:1–6CrossRefPubMed

19.

Suh CH, Kim KW, Kim GY, Shin YM, Kim PN, Park SH (2015) The diagnostic value of Gd-EOB-DTPA-MRI for the diagnosis of focal nodular hyperplasia: a systematic review and meta-analysis. Eur Radiol 25:950–960CrossRefPubMed

20.

McInnes MD, Hibbert RM, Inacio JR, Schieda N (2015) Focal nodular hyperplasia and hepatocellular adenoma: accuracy of gadoxetic acid-enhanced MR imaging–a systematic review. Radiology 277:413–423CrossRefPubMed

21.

Bioulac-Sage P, Cubel G, Taouji S et al (2012) Immunohistochemical markers on needle biopsies are helpful for the diagnosis of focal nodular hyperplasia and hepatocellular adenoma subtypes. Am J Surg Pathol 36:1691–1699CrossRefPubMed

22.

Morana G, Grazioli L, Kirchin MA et al (2011) Solid hypervascular liver lesions: accurate identification of true benign lesions on enhanced dynamic and hepatobiliary phase magnetic resonance imaging after gadobenate dimeglumine administration. Invest Radiol 46:225–239CrossRefPubMed

23.

Stoot JH, Coelen RJ, De Jong MC, Dejong CH (2010) Malignant transformation of hepatocellular adenomas into hepatocellular carcinomas: a systematic review including more than 1600 adenoma cases. HPB (Oxford) 12:509–522CrossRef

24.

van Aalten SM, de Man RA, IJzermans JN, Terkivatan T (2012) Systematic review of haemorrhage and rupture of hepatocellular adenomas. Br J Surg 99:911–916CrossRefPubMed

25.

Atwell TD, Smith RL, Hesley GK et al (2010) Incidence of bleeding after 15,181 percutaneous biopsies and the role of aspirin. AJR Am J Roentgenol 194:784–789CrossRefPubMed

26.

Younossi ZM, Teran JC, Ganiats TG, Carey WD (1998) Ultrasound-guided liver biopsy for parenchymal liver disease: an economic analysis. Dig Dis Sci 43:46–50CrossRefPubMed

27.

Andersson KL, Salomon JA, Goldie SJ, Chung RT (2008) Cost effectiveness of alternative surveillance strategies for hepatocellular carcinoma in patients with cirrhosis. Clin Gastroenterol Hepatol 6:1418–1424CrossRefPubMedPubMedCentral

28.

Janes CH, Lindor KD (1993) Outcome of patients hospitalized for complications after outpatient liver biopsy. Ann Intern Med 118:96–98CrossRefPubMed

29.

Kim Y, Shin S, Park J et al (2013) Costing methods in healthcare. National Evidence-based Healthcare Collaborating Agency.

30.

Mohajer K, Frydrychowicz A, Robbins JB, Loeffler AG, Reed TD, Reeder SB (2012) Characterization of hepatic adenoma and focal nodular hyperplasia with gadoxetic acid. J Magn Reson Imaging 36:686–696CrossRefPubMedPubMedCentral

31.

Seale MK, Catalano OA, Saini S, Hahn PF, Sahani DV (2009) Hepatobiliary-specific MR contrast agents: role in imaging the liver and biliary tree. Radiographics 29:1725–1748CrossRefPubMed

32.

Van Kessel CS, De Boer E, Ten Kate FJW, Brosens LAA, Veldhuis WB, Van Leeuwen MS (2013) Focal nodular hyperplasia: hepatobiliary enhancement patterns on gadoxetic-acid contrast-enhanced MRI. Abdom Imaging 38:490–501CrossRefPubMed

33.

Halavaara J, Breuer J, Ayuso C et al (2006) Liver tumor characterization: comparison between liver-specific gadoxetic acid disodium-enhanced MRI and biphasic CT–a multicenter trial. J Comput Assist Tomogr 30:345–354CrossRefPubMed

34.

Bioulac-Sage P, Balabaud C, Wanless IR (2001) Diagnosis of focal nodular hyperplasia: not so easy. Am J Surg Pathol 25:1322–1325CrossRefPubMed

35.

Zech CJ, Bartolozzi C, Bioulac-Sage P et al (2013) Consensus report of the Fifth International Forum for Liver MRI. AJR Am J Roentgenol 201:97–107CrossRefPubMed

36.

Agarwal S, Fuentes-Orrego JM, Arnason T et al (2014) Inflammatory hepatocellular adenomas can mimic focal nodular hyperplasia on gadoxetic acid-enhanced MRI. AJR Am J Roentgenol 203:W408–W414CrossRefPubMed

Title: A cost-effectiveness analysis of the diagnostic strategies for differentiating focal nodular hyperplasia from hepatocellular adenoma
Authors: Chong Hyun Suh
Kyung Won Kim
Seong Ho Park
Sangjin Shin
Jeonghoon Ahn
Junhee Pyo
Atul B. Shinagare
Katherine M. Krajewski
Nikhil H. Ramaiya
Publication date: 01-01-2018
Publisher: Springer Berlin Heidelberg
Published in: European Radiology / Issue 1/2018
Print ISSN: 0938-7994
Electronic ISSN: 1432-1084
DOI: https://doi.org/10.1007/s00330-017-4967-9

Keynote webinar | Spotlight on medication adherence

Springer Medicine

A cost-effectiveness analysis of the diagnostic strategies for differentiating focal nodular hyperplasia from hepatocellular adenoma

Abstract

Objectives

Methods

Results

Conclusions

Key points

Keynote webinar | Spotlight on medication adherence

Springer Medicine

Abstract

Objectives

Methods

Results

Conclusions

Key points

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