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

Abstract Background and aims Reinforced hepatocellular carcinoma (HCC) surveillance using magnetic resonance imaging (MRI) could increase early tumour detection but faces cost-effectiveness issues. The aim of this study was to evaluate the cost-effectiveness of MRI for the detection of very early HCC (BCLC 0) in patients with an annual HCC risk>3%. Methods French patients with compensated cirrhosis included in four 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 LY. Results Among 2513 patients with nonviral causes of cirrhosis (n=840) and/or cured HCV (n=1489)/controlled HBV infection (n=184), 206 cases of HCC were detected after a 37-month follow-up. When applied to training (n=1658) 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 five times 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. Conclusions 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.