ECONOMIC EVALUATON OF NON-INVASIVE INVESTIGATION OF STATIC AND DYNAMIC LIVER FUNCTION TO ASSIST CLINICAL DECISION MAKING IN HEPATUCELLULAR CARCINOMA

Purpose: Surgeons undertaking resections of the liver in patient with hepatocellular carcinoma are challenged with poor knowledge on both global and regional liver function. Recent research has focused on the use of non-invasive investigation of both static and dynamic liver function to assist clinical decision making. The value of this emerging diagnostic technology is unknown, and the aim of the study was to perform an early assessment of costs and health outcomes.

   Method(s): A decision analytic model was developed to estimate healthcare costs and QALYs for a clinical practice strategy and a diagnostic strategy in patients with hepatocellular carcinoma. The clinical practice strategy reflects current clinical decision making. The diagnostic strategy uses a non-invasive diagnostic technology that determines several central aspects of liver function based on magnetic resonance imaging, and processes this information into a visualization tool to support clinical decision making. The decision analytic model incorporates how knowledge of liver function status may impact treatment decisions and the prognosis of implemented treatments due to increased surgical precision. Expert opinion was used to estimate the impact on treatment decisions, the Swedish registry of tumors in the liver and bile ducts (Sweliv), together with published literature was used to inform long-term prognosis of implemented treatments. To reflect the substantial uncertainty associated with the use of the new diagnostic strategy, extensive sensitivity scenarios were investigated. Costs and QALYs were estimated from a Swedish healthcare perspective.

Result(s): In the most plausible scenarios, QALYs gained with a diagnostic strategy varied between 0.07 and 0.26, yielding cost per QALY estimates of €7500 to €3500 compared with a clinical practice strategy. Treatment decisions (a larger proportion of patients undergoing resection) and improved long-term prognosis (due to optimal resection) contributed equally to the gain in QALYs. Incremental costs associated with the diagnostic strategy were primarily driven by resection costs and additional costs associated with improved survival, and not the actual cost of the diagnostic procedure.

Conclusion(s): This early evaluation indicates that a diagnostic visualization tool in patients with hepatocellular carcinoma will improve health outcomes at a cost below generally acceptable thresholds of cost-effectiveness. Furthermore, the evaluation provides a structured framework to prioritize further research, and also to assess the value of the diagnostic technology in other disease areas than hepatocellular carcinoma.