Is non-contrast enhanced magnetic resonance imaging cost-effective for screening of hepatocellular carcinoma?

Introduction Ultrasound (US) is current standard of care for imaging surveillance in patients at risk for hepatocellular carcinoma (HCC). Magnetic resonance imaging (MRI) has been explored as an alternative, given the higher sensitivity of MRI, although this comes at a higher cost. We performed a cost-effective analysis comparing US and a dual-sequence non-contrast MRI (NCEMRI) for HCC surveillance, in the local setting. Methods Cost-effectiveness analysis of no surveillance, US surveillance and NCEMRI surveillance was performed using Markov modelling and microsimulation. At-risk patient cohort was simulated and followed-up for 40 years to estimate their disease status, direct medical costs, and effectiveness. Quality-adjusted life years (QALYs) and incremental cost effectiveness ratio were calculated. Results 482,000 patients with an average age of 40 years were simulated and followed up for 40 years. The average total costs and QALYs for the three scenarios - no surveillance, US surveillance and NCEMRI surveillance were S$1,193/7.460 QALYs; S$8,099/11.195 QALYs; S$9,720/11.366 QALYs, respectively. Conclusion Despite NCEMRI having a superior diagnostic accuracy, it is a less cost-effective strategy than US for HCC surveillance in the general at-risk population. Future local cost-effectiveness analyses should include stratifying surveillance methods with a variety of imaging techniques (US, NCEMRI, CEMRI) based on patients' risk profiles.