PMU15 Comparison of Clinical and Economical Outcomes of Alternative Imaging Methods in Turkey

Abstract

Magnetic resonance imaging (MRI) with Gadobutrol (GAD), MRI with Gadoteric Acid (GOT), and peripheral angiography (PA) methods are used in the diagnosis of vascular disease (VD). MRI with Gadoxetic-acid (GAX), MRI with extracellular contrast agent (ECCM), or contrast CT (CCT) are used for the diagnosis of liver metastasis (LM). The study aimed to compare the clinical and economic outcomes of alternative imaging methods in the diagnosis of VD and LM in Turkey. The clinical and economic data were examined through a literature review. An expert opinion survey conducted for the missing data. The data gathered from literature and expert opinions analyzed via the decision tree model. In case of no diagnosis with GAD for VD; it is modeled that MR contrast imaging applied with GOT; or vice versa. PA was performed in cases in which diagnoses couldn’t be made using both agents with MRI. The same model tree used for if the patient didn`t get diagnosed with GAX or ECCM or CCT for LM, then MRI contrast imaging was applied with another agent. Reimbursement guidelines of the Social Security Institution were used for cost calculations. The cost per patient with the diagnosis with VD was calculated via a decision tree as 245 TL for GAD and 251 TL for GOT. 7% less PA was needed in the GAD which avoids 29% less unnecessary treatment compared to GOT. The diagnosis rate was 99% with GAX, 82% with ECCM, and 60% with CCT for LM. The cost of diagnosis per patient with LM was 280 TL for CT, 229 TL for ECCM, and 280 TL for GAX. GAD offered more favorable cost, a higher rate of correct diagnosis, and fewer patients who needed PA. GAX as the gold standard in patients with LM according to clinical guidelines.