Lawrence Genen BA, Presenter: Nothing to Disclose

Chin Hur MD, Abstract Co-Author: Nothing to Disclose

Raymond Chung MD, Abstract Co-Author: Nothing to Disclose

G. Scott Gazelle MD, Abstract Co-Author: Nothing to Disclose

Extensive waiting list time associated with liver transplantation for hepatocellular carcinoma (HCC) results in two primary treatment options for patients – surgical resection or radio-frequency ablation (RFA). The purpose of this study was to evaluate the cost-effectiveness of RFA compared with hepatic resection for the treatment of primary HCC in transplant-eligible patients.

We developed a state-transition Monte Carlo decision model to evaluate the relative (societal) cost-effectiveness of radio-frequency ablation in patients with primary HCC. All patients enter the model with CT-proven primary HCC, underlying Child’s A cirrhosis and are transplant and resection eligible. The model tracked the presence, number, size, location, morphology, growth, detection, removal and recurrence of up to 3 individual lesions. Survival, quality of life, and cost are predicted on the basis of treatment strategy and disease extent which was explicitly modeled through the combined use of Child-Pugh Classification and Okuda Staging. A reference strategy in which no diagnostic evaluation or treatment is performed was also modeled for comparison. Extensive sensitivity analysis was performed to evaluate the impact of varying model parameters on results.

In the base-case analysis, a strategy of RFA with CT follow-up every 6 months resulted in a gain of 3.89 quality-adjusted life-years (QALYs), relative to the no-test/no-treat strategy, at an incremental cost of $20,679/QALY. When RFA was compared to hepatic resection, the incremental cost-effectiveness ratio (ICER) was $18,606/QALY. The findings of the model were robust and were not sensitive to changes in most model parameters analyzed, but were sensitive to changes in post-treatment survival rates. If survival rates post-ablation were 30% less than resection, resection became the more effective strategy.

Radiofrequency ablation is a cost-effective treatment strategy for primary HCC in transplant-eligible patients when compared to hepatic resection and should be considered for this patient population.

Genen, L, Hur, C, Chung, R, Gazelle, G, Cost-Effectiveness of Radio-Frequency Ablation for the Treatment of Primary Hepatocellular Carcinoma in Transplant Eligible Patients: A State-Transition Monte Carlo Decision Analysis.  Radiological Society of North America 2004 Scientific Assembly and Annual Meeting, November 28 - December 3, 2004 ,Chicago IL. http://archive.rsna.org/2004/4408341.html