Cost-effectiveness of hepatic resection versus percutaneous radiofrequency ablation for early hepatocellular carcinoma

BACKGROUND & AIMS: Both hepatic resection and radiofrequency ablation (RFA) are considered curative treatments for hepatocellular carcinoma (HCC), but their economic impact still remains not determined. Aim of the present study was to analyze the cost-effectiveness (CE) of these two strategies in early stage HCC (Milan criteria). METHODS: As first step, a meta-analysis of the pertinent literature of the last decade was performed. Seventeen studies fulfilled the inclusion criteria: 3,996 patients underwent resection and 4,424 underwent RFA for early HCC. Data obtained from the meta-analysis were used to construct a Markov model. Costs were assessed from the health care providers perspective. A Monte-Carlo probabilistic sensitivity analysis was used to estimate outcomes with distribution samples of 1,000 patients for each treatment arm. RESULTS: In a 10 year perspective, for very early HCC (single nodule <2cm) in Child-Pugh class A patients, RFA provided similar life-expectancy and quality-adjusted life-expectancy at a lower cost than resection and was the most cost-effective therapeutic strategy. For single HCCs of 3-5cm, resection provided better life-expectancy and was more cost-effective than RFA, at a willingness-to-pay above €4,200 per quality-adjusted life-year. In the presence of two or three nodules ⩽3cm, life-expectancy and quality-adjusted life-expectancy were very similar between the two treatments, but cost-effectiveness was again in favour of RFA. CONCLUSIONS: For very early HCC and in the presence of two or three nodules ⩽3cm, RFA is more cost-effective than resection; for single larger early stage HCCs, surgical resection remains the best strategy to adopt as a result of better survival rates at an acceptable increase in cost.