Page 176 - ebook HCC

174 PROGRAMME AND ABSTRACTS GENEVA, SWITZERLAND EASL HCC SUMMIT 175
FEBRUARY 13 - 16, 2014

COST EFFICACY ANALYSIS OF HCC SCREENING DIAGNOSIS OF HCC

1
Morris Sherman , Wendong Chen 1 Ahmed Ba-Ssalamah 1
1 University of Toronto, Toronto, Canada 1 Radiology, Medical University of Vienna, Vienna, Austria
Corresponding author’s e-mail: Dr.Morris.Sherman@uhn.ca Corresponding author’s e-mail: ahmed.ba-ssalamah@meduniwien.ac.at

There have been about 10 cost efficacy analyses looking at screening for HCC. Each The introduction of multidetector CT (MDCT) for abdominal imaging has changed the face
describes a different model of the disease, with different transition frequencies, different of the diagnostic work-up of HCC. MDCT scans can acquire thin slices less than 1 mm
starting populations, and different interventions. However, most come to the conclusion thick over a large volume in less than 20 seconds during one breath-hold. In combination
that screening for HCC is effective and cost effective, meaning that the intervention with optimized contrast material administration, using a care bolus technique, and the
prolongs life over the whole cohort by more than 3 months, and does so at an incremental performance of 3 D reconstructions, we not only can detect and characterize HCC lesions,
cost-effectiveness ratio of less than $50,000/QALY. However, different analyses come to but also obtain a complete staging of the disease in the chest, the whole abdomen (including
different conclusions as which method of HCC screening is most cost effective. Some lymph nodes), as well as the musculoskeletal system. Therefore, CT scan has become
describe testing with AFP as the most cost effective, whereas others find that either the workhorse in the diagnostic work-up of HCC. The use of a combined PET-CT scan is
ultrasound alone or ultrasound plus AFP is most cost effective. CT scan and MRI, with revolutionary for oncologic diseases; however, its value is limited in the initial diagnosis of
one exception, are found to be cost-ineffective. We constructed a systematic review of HCC, but may be helpful during follow-up to detect recurrent disease or distant metastases.
meta-analyses of HCC screening. We found 12 studies meeting our criteria. Results were The continuous development of MRI hardware and software technology, including the use
expressed a ratio normalized for gross domestic product of the country where the analysis of high-field-strength (3 Tesla) scanners in daily clinical practice, has made this technique
was done. This allowed comparison of costs between studies in different countries. The the most sensitive and specific imaging modality for the detection of HCC. Using new
analysis found that screening with ultrasound alone at 6 monthly intervals was the most sequences, such as DWI and SWI, it is possible to differentiate the numerous nodules that
occur with liver cirrhosis, such as regenerative nodules and dysplastic nodules, especially
cost-effective method of HCC screening. This is validation of the AASLD and EASL
CLINICAL SPEAKERS ABSTRACTS in combination with DWI is considered the most sensitive technique for the follow-up of CLINICAL SPEAKERS ABSTRACTS
after administration of hepatobiliary contrast agents. Furthermore, contrast-enhanced MRI
recommendations.
HCC after TACE or RFA. In this presentation, the diagnostic radiologic algorithm for the
differential diagnosis of HCC, and the treatment options based on radiologic findings, as
well as follow-up and surveillance, will be discussed.