Whole-Body MR Imaging versus Sequential Multimodal Diagnostic Algorithm for Staging Patients with Rectal Cancer: Cost Analysis

Zusammenfassung

Ziel: Vergleich der direkten Kosten von 2 diagnostischen Algorithmen für das prätherapeutische TNM-Staging des Rektumkarzinoms. Material und Methoden: In einer Studie mit 33 Patienten (mittleres Alter 62,5 Jahre) wurden direkte und variable Kosten eines sequenziellen multimodalen Algorithmus (Rektoskopie, endoskopischer und abdominaler Ultraschall, Thorax-Röntgen, CT bei Verdacht auf fokale Leberläsion oder Lungenrundherd) mit denen eines neuen Algorithmus aus Rektoskopie und MRT in einem Ganzkörperscanner verglichen. Die MRT beinhaltete T 2w-Sequenzen des Rektums, 3-D-T1w-Sequenzen der Leber und des Thorax nach Bolusinjektion von gadoxetic acid, und späte Phasen der Leber im organspezifischen Kontrast. Die Arbeitsprozesse, die verwendeten Materialien und die Arbeitszeit der involvierten Personalrollen wurden anhand von Interviews der Prozessverantwortlichen (Chirurg, Gastroenterologe, 2 Radiologen) dokumentiert. Die Personal- und Materialkosten wurden mittels Tarifverträgen und Daten aus dem Einkauf bestimmt. Die direkten Festkosten wurden anhand von Preisangaben der Hersteller berechnet. Ergebnisse: Die mittlere MR-Untersuchungszeit betrug 55 min. Die CT wurde bei 19 / 33 Patienten (57 %) durchgeführt und führte zu einer Verlängerung des stationären Aufenthalts um einen Tag (Kosten 374 €). Die Modalitäten- und Materialkosten lagen für die MRT höher (Modalitäten 116 versus 30 €, Material 159 versus 60 € pro Patient). Die Personalkosten lagen für die MRT deutlich niedriger (436 versus 732 € pro Patient). Insgesamt betrug der Kostenvorteil der MRT gegenüber dem sequenziellen Algorithmus 31,3 % (711 versus 1035 €). Schlussfolgerung: Im präoperativen TNM-Staging von Patienten mit einem Rektumkarzinom könnten durch die MRT deutliche Kostenvorteile erzielt werden.

Abstract

Purpose: To compare the direct costs of two diagnostic algorithms for pretherapeutic TNM staging of rectal cancer. Materials and Methods: In a study including 33 patients (mean age: 62.5 years), the direct fixed and variable costs of a sequential multimodal algorithm (rectoscopy, endoscopic and abdominal ultrasound, chest X-ray, thoracic/abdominal CT in the case of positive findings in abdominal ultrasound or chest X-ray) were compared to those of a novel algorithm of rectoscopy followed by MRI using a whole-body scanner. MRI included T 2w sequences of the rectum, 3D T 1w sequences of the liver and chest after bolus injection of gadoxetic acid, and delayed phases of the liver. The personnel work times, material items, and work processes were tracked to the nearest minute by interviewing those responsible for the process (surgeon, gastroenterologist, two radiologists). The costs of labor and materials were determined from personnel reimbursement data and hospital accounting records. Fixed costs were determined from vendor pricing. Results: The mean MRI time was 55 min. CT was performed in 19 / 33 patients (57 %) causing an additional day of hospitalization (costs 374 €). The costs for equipment and material were higher for MRI compared to sequential algorithm (equipment 116 vs. 30 €; material 159 vs. 60 € per patient). The personnel costs were markedly lower for MRI (436 vs. 732 € per patient). Altogether, the absolute cost advantage of MRI was 31.3 % (711 vs. 1035 € for sequential algorithm). Conclusion: Substantial savings are achievable with the use of whole-body MRI for the preoperative TNM staging of patients with rectal cancer.

Key words

MR imaging - CT spiral - colorectal carcinoma - cost-cost analysis (CCA) - gadoxetic acid - total mesorectal excision (TME)

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