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Early hepatocellular carcinoma detection using magnetic resonance imaging is cost-effective in high-risk patients with cirrhosis

2021; Elsevier BV; Volume: 4; Issue: 1 Linguagem: Inglês

10.1016/j.jhepr.2021.100390

2589-5559

Pierre Nahon, Marie Najean, Richard Layese, Kevin Zarca, Laeticia Blampain Segar, Carole Cagnot, Nathalie Ganne–Carrié, G. Nkontchou, Stanislas Pol, Cendrine Chaffaut, Fabrice Carrat, Maxime Ronot, Étienne Audureau, Isabelle Durand‐Zaleski, Pierre Nahon, Tarik Asselah, Dominique Guyader, Stanislas Pol, Hélène Fontaine, Georges‐Philippe Pageaux, Victor de Lédinghen, Denis Ouzan, Fabien Zoulim, Dominique Roulot, Albert Tran, Jean‐Pierre Bronowicki, Thomas Decaensi, Ghassan Riachi, Paul Calès, Jean‐Marie Péron, Laurent Alric, Marc Bourlière, Philippe Mathurin, Sébastien Dharancy, Jean–Frédéric Blanc, Armand Abergel, Olivier Chazouillères, Ariane Mallat, Jean‐Didier Grangé, P Attali, Louis d’Altéroche, Claire Wartelle, Thông Dao, Dominique Thabut, Christophe Pilette, Christine Silvain, Christos Christidis, Eric Nguyen‐Khac, Brigitte Bernard‐Chabert, Sophie Hillaire, Vincent Di Martino, Delphine Bonnet, Virginie Payssan-Sicart, Chloe Pomes, François Bailly, Marjolaine Beaudoin, Dominique Giboz, Kerstin Hartig-Lavie, M. Travis Maynard, Eric Billaud, D. Boutoille, Morane Cavellec, Marjorie Cheraud-Carpentier, Isabelle Hubert, Jaouad Benhida, Adrien Lannes, F. Lunel, F. Oberti, Nathalie Boyer, Nathalie Giuily, Corinne Castelnau, Giovanna Scoazec, Aziza Chibah, Sylvie Keser, Karim Bonardi, Anaïs Vallet‐Pichard, Philippe Sogni, Juliette Foucher, Jean‐Baptiste Hiriart, Amy C. Wilson, Sarah Shili, Faïza Chermak, Christelle Ansaldi, Nisserine Ben Amara, Laëtitia Chouquet, Emilie De Luca, Valérie Oulès, Rodolphe Anty, Ève Gelsi, Régine Truchi, Elena Luckina, Nadia Messaoudi, Joseph Moussali, Barbara De Dieuleveult, Damien Labarrière, Pascal Poter, Si Nafa Si Ahmed, Véronique Grando–Lemaire, Pierre Nahon, Valérie Bourcier, Séverine Brulé, Thomas Stalhberger, Caroline Jézéquel, Audrey Brener, Anne Laligant, Aline Rabot, Isabelle Renard, Thomas F. Baumert, Michel Doffoël, Catherine Schmidt‐Mutter, Pauline Simo‐Noumbissie, Esma Razi, Hélène Barraud, Mouni Bensenane, Abdelbasset Nani, Sarah Hassani-Nani, Marie-Albertine Bernard, Georges‐Philippe Pageaux, Michaël Bismuth, Ludovic Caillo, Stéphanie Faure, M.P. Ripault, Christophe Bureau, Jean Marie Péron, Marie Angèle Robic, Léa Tarallo, Marine Faure, Bruno Froissart, Marie‐Noëlle Hilleret, Jean–Pierre Zarski, Odile Goria, Victorien Grard, Hélène Montialoux, Muriel François, Christian Ouedraogo, Christelle Pauleau, Anne Varault, Tony Andréani, Bénédicte Angoulevant, Azeline Chevance, Lawrence Serfaty, Térésa Antonini, Audrey Coilly, Jean‐Charles Duclos Vallée, Mariagrazia Tateo, Christophe Bonny, Chanteranne Brigitte, Géraldine Lamblin, Léon Muti, Abdenour Babouri, Virginie Filipe, Camille Barrault, Laurent Costes, Hervé Hagège, Soraya Merbah, Paul Carrier, Maryline Debette‐Gratien, Jérémie Jacques, Guillaume Lassailly, Florent Artu, V. Canva, Sébastien Dharancy, Alexandre Louvet, Marianne Latournerie, Marc Bardou, Thomas Mouillot, Yannick Bacq, Didier Barbereau, Charlotte Nicolas, Caroline Chevalier, Isabelle Archambeaud, Sarah Habès, Nisserine Ben Amara, Danièle Botta-Fridlund, Eric Saillard, Marie-Josée Lafrance, Marc Bourlière, P. Cacoub, Fabrice Carrat, Patrizia Carrieri, Elisabeth Delarocque‐Astagneau, Victor de Lédinghen, Céline Dorival, Jean Dubuisson, Hélène Fontaine, Chantal Housset, Dominique Larrey, Patrick Marcellin, Philippe Mathurin, Pierre Nahon, Georges‐Philippe Pageaux, Jean‐Michel Pawlotsky, Ventzislava Petrov–Sanchez, Stanislas Pol, Sophie Vaux, Linda Wittkop, Yazdan Yazdanpanah, Jean–Pierre Zarski, Fabien Zoulim, Jessica Zucman‐Rossi, Nathalie Ganne–Carrié, Cendrine Chaffaut, Isabelle Archambeaud, Louis d’Altéroche, F. Oberti, Dominique Roulot, Christophe Moreno, Alexandre Louvet, Thông Dao, Romain Moirand, Odile Goria, Eric Nguyen‐Khac, Nicolas Carbonell, Jean-Charles Duclos-Vallée, Stanislas Pol, Victor de Lédinghen, Violaine Ozenne, Jean Henrion, Jean‐Marie Péron, Albert Tran, Gabriel Perlemuter, Xavier Amiot, Jean–Pierre Zarski, Sylvie Chevret,

Liver Disease and Transplantation

Reinforced hepatocellular carcinoma (HCC) surveillance using magnetic resonance imaging (MRI) could increase early tumour detection but faces cost-effectiveness issues. In this study, we aimed to evaluate the cost-effectiveness of MRI for the detection of very early HCC (Barcelona Clinic Liver Cancer [BCLC] 0) in patients with an annual HCC risk >3%.French patients with compensated cirrhosis included in 4 multicentre prospective cohorts were considered. A scoring system was constructed to identify patients with an annual risk >3%. Using a Markov model, the economic evaluation estimated the costs and life years (LYs) gained with MRI vs. ultrasound (US) monitoring over a 20-year period. The incremental cost-effectiveness ratio (ICER) was calculated by dividing the incremental costs by the incremental LYs.Among 2,513 patients with non-viral causes of cirrhosis (n = 840) and/or cured HCV (n = 1,489)/controlled HBV infection (n = 184), 206 cases of HCC were detected after a 37-month follow-up. When applied to training (n = 1,658) and validation (n = 855) sets, the construction of a scoring system identified 33.4% and 37.5% of patients with an annual HCC risk >3% (3-year C-Indexes 75 and 76, respectively). In patients with a 3% annual risk, the incremental LY gained with MRI was 0.4 for an additional cost of €6,134, resulting in an ICER of €15,447 per LY. Compared to US monitoring, MRI detected 5x more BCLC 0 HCC. The deterministic sensitivity analysis confirmed the impact of HCC incidence. At a willingness to pay of €50,000/LY, MRI screening had a 100% probability of being cost-effective.In the era of HCV eradication/HBV control, patients with annual HCC risk >3% represent one-third of French patients with cirrhosis. MRI is cost-effective in this population and could favour early HCC detection.The early identification of hepatocellular carcinoma in patients with cirrhosis is important to improve patient outcomes. Magnetic resonance imaging could increase early tumour detection but is more expensive and less accessible than ultrasound (the standard modality for surveillance). Herein, using a simple score, we identified a subgroup of patients with cirrhosis (accounting for >one-third), who were at increased risk of hepatocellular carcinoma and for whom the increased expense of magnetic resonance imaging would be justified by the potential improvement in outcomes.