Abstract
PURPOSE: To perform a cost-effectiveness analysis comparing liver resection, percutaneous thermal ablation (TA), and radiation segmentectomy (RS) for solitary hepatocellular carcinoma (HCC) ≤ 3 cm with curative intent.
METHODS: A cost-effectiveness analysis was performed comparing resection, TA and RS for patients with solitary HCC ≤ 3 cm using a time horizon from a United States (US) payor's perspective over 5 years using Markov modeling. Clinical outcomes were pooled from four comparative studies between ablation and resection. The outcomes after RS were pooled using three published studies and institutional data. Base case calculation, probabilistic and deterministic sensitivity analyses were performed.
RESULTS: Base case calculation showed TA to be the most cost-effective strategy. RS had the highest effectiveness (RS: 3.31 QALY, 95% confidence interval (CI): 3.305-3.315; resection: 3.29 QALY, 95% CI: 3.286-3.294) and TA had the lower effectiveness of 3.20 (95% CI: 3.196-3.204) QALY. Probabilistic sensitivity analysis showed ablation to be the most cost-effective strategy in 68.7% of iterations, resection 20.6% and RS 10.8%. TA was the most cost-effective if its quarterly distant recurrence risk was lower than 2.8% (base case 2.5%). Sensitivity analyses varying procedural costs showed resection to be cost-effective when its cost was below $26,779 or RS to be cost-effective when its cost was lower than $11,857.
CONCLUSION: Ablation was the most cost-effective treatment of curative intent for patients with solitary HCC ≤ 3 cm, with RS having the highest effectiveness but overall higher cost driven by large proportion of surviving patients requiring routine follow-up care.