Original Title: Application 1110

Authors' results and conclusions: Safety-No physical harms were reported as resulting directly from the MRI staging procedure or the comparative staging techniques. Harms are very rare provided suitable precautions are taken. However, patients must be screened for ferromagnetic or electrical implants prior to a MRI, as they may dislodge or become disrupted by the strong magnetic fields. A small proportion of patients will suffer from claustrophobia and so find the MRI procedure distressing. Harms may arise as a result of incorrect staging, so safety is linked to the accuracy of the staging techniques. Effectiveness-There was very little evidence comparing the accuracy of MRI against other forms of preoperative imaging. On the basis of one study per comparison, MRI and multi-slice computed tomography (MSCT) appear to have similar accuracy for predicting T stage and N stage, while MRI was more accurate at predicting N stage than either conventional CT along or endorectal ultrasound (ERUS). The expert opinion of the Advisory Panel is that MRI provides superior contrast resolution to MSCT and is more effective at defining the circumferential resection margin. Use of MRI to determine whether patients should receive neoadjuvant therapy or proceed to primary surgery is likely to result in an increased number of patients being recommended for primary surgery when compared to patients staged by conventional CT or ERUS (assuming that patients would otherwise receive neoadjuvant therapy). Economics-It is estimated that funding MRI for newly diagnosed patients would cost $1,162,024 to society, of which $1,103,174 would be borne by the Australian Government. It is possible that the additional costs would be counteracted by less use of neoadjuvant therapy. The cost offset to the Australian Government of reduced neoadjuvant therapy is estimated to be $1,512,661 per year. If the cost savings from reduced neoadjuvant therapy use are used to offset the costs of MRI, there would be an overall cost saving of $499,487 to the Australian Government and $5,636,565 to society.

Project Status: Completed

URL for project: http://www.msac.gov.au/internet/msac/publishing.nsf/Content/1110-public

Year Published: 2008

URL for published report: http://www.msac.gov.au/internet/msac/publishing.nsf/Content/6D7DBE771FA91DF2CA25801000123B0F/$File/1110-Assessment-Report.pdf

English language abstract: An English language summary is available

Publication Type: Not Assigned

Country: Australia

Organisation Name: Adelaide Health Technology Assessment

Contact Address: School of Public Health, Mail Drop 545, University of Adelaide, Adelaide SA 5005, AUSTRALIA, Tel: +61 8 8313 4617

Contact Name: ahta@adelaide.edu.au

Contact Email: ahta@adelaide.edu.au

Copyright: Adelaide Health Technology Assessment (AHTA)