Health economic aspects of evaluation with diffusion weighted MR and MR colonography compared to standard evaluation with colonoscopy and CT before rectal cancer surgery

BACKGROUND: Colorectal cancer is a frequent type of cancer, and with the risk of synchronous disease, the need for a complete staging leads to an extensive and costly preoperative diagnostic evaluation. Previously we described a total preoperative evaluation using magnetic resonance (MR) colonography and diffusion-weighted MR of the liver.

PURPOSE: To compare the economic aspects of this modality with the standard evaluation in an analysis of the different cost drivers.

MATERIAL AND METHODS: Based on the results from previous studies, two calculations were performed, a theoretical cost calculation and a practical cost calculation. The cost drivers utilized are an average cost based on the cost of all procedures and diagnostic modalities performed in hospitalized patients (DRG) and outpatients (DAGS [Danish outpatient grouping system]) in Denmark.

RESULTS: The total cost for a full colorectal evaluation and computed tomography (CT) scan of the thorax/abdomen was less for the new modality group in all theoretical models proposed; €225 using model A, €322 using model B, and €383 using model C. Using results from previous studies, the actual difference and the potential difference in cost between the two preoperative diagnostic modalities per patient were €312 and €712, respectively.

CONCLUSION: This cost analysis shows the cost effectiveness of the new modality as the future standard preoperative diagnostic work-up by reducing total cost and by having a higher sensitivity and completion rate.