Cost analysis of recall strategies for non-invasive diagnosis of small hepatocellular carcinoma

Background: Which is the least expensive recall policy for nodules in the cirrhotic liver remains unclear.

Aim: Aim of the study was to analyze the costs of different recall diagnostic strategies of hepatocellular carcinoma (HCC) on cirrhosis on a real series of patients.

Methods: 75 consecutive small liver nodules (10-30 mm) detected at conventional ultrasonography in 60 patients with cirrhosis were submitted to contrast-enhanced ultrasound, computed tomography and gadolinium-magnetic resonance imaging with a final diagnosis established according to the latest guidelines which include different strategies for nodules 10-19 mm or > or =20mm. The actual costs required to fully characterise any nodule and staging HCC in every patient, if one or the other imaging modality had been used as the first diagnostic step, were calculated. The theoretical hypothesis that each nodule was present in each patient was also investigated from an economical point of view.

Results: The recall strategy starting with contrast-enhanced ultrasound plus computed tomography is the least expensive strategy for patients with at least one nodule 10-19 mm in size, in nearly all combinations (single or double nodules). In patients with single 20-30 mm nodules the least expensive strategy is to start with computed tomography and to use contrast-enhanced ultrasound as a second step technique.

Conclusions: wider use of contrast-enhanced ultrasound has the potential to save healthcare costs after first ultrasound detection of a single small nodule in cirrhosis.