Health economic evaluation of ferucarbotran-enhanced MRI in the diagnosis of liver metastases in colorectal cancer patients

Abstract

The objective of our study was to analyze the health economic impact of ferucarbotran-enhanced magnetic resonance imaging (MRI) in the diagnosis of hepatic colorectal cancer metastases based on observed changes in medical management. A decision tree simulating a patient's medical management was designed, comparing two scenarios: contrast-enhanced spiral computed tomography-based vs ferucarbotran-enhanced MRI-based (Resovist, Bayer Schering Pharma AG, Germany) diagnosis. A clinical trial in patients with presumed liver metastases (n=36) provided data on clinical decisions regarding the medical management options in relation to diagnostic outcomes: resection, chemotherapy, or best supportive care. A "gold standard" was established afterward, combining all the available clinical, imaging, laboratory, and pathology findings. A multidisciplinary panel formed by a hepatologist, a liver surgeon, and an interventional radiologist decided on the recommended medical management for each patient. Costs of medical resources associated with each management option (all expressed in Euro) were obtained from the public health insurance (average European values). Life expectancies for the different options were obtained from literature. Despite an initial extra cost of 338 Euro, a significant net saving of 1,443 Euro was obtained with ferucarbotran-enhanced MRI mainly because of avoiding unnecessary surgery. There was no significant difference in the predicted life expectancy between both arms, despite the large difference in medical decision. In this comparative medical decision analysis, it was shown that ferucarbotran-enhanced MRI has the potential to improve medical management and save health care costs.