Cost-effectiveness of radiofrequency ablation and surgical therapy for small hepatocellular carcinoma of 3cm or less in diameter.
BACKGROUND
Cost-effectiveness of radiofrequency ablation (RFA) was assessed in treatment of hepatocellular carcinoma (HCC).


METHODS
During 5 years, 153 patients with HCC of 3cm or less received RFA, and 60 underwent surgery. Judgment after RFA therapy was classified into three grades: residual tumor (grade 1), necrotic area with a less safety margin of 5mm (grade 2), and necrosis with a safety margin of 5mm in all directions (grade 3).


RESULTS
Local recurrence rates after RFA and surgery were 7.9% and 0% at the third year. The rates in patients with grades 2 and 3 after RFA were 18.7% and 1.2% at the third year, respectively (P=0.0005). Among 91 patients with grades 1 and 2 necrosis after initial therapy, 52 received additional ablation. Although local recurrence rate was 24.9% in 39 patients without additional therapy, the rates after therapy repetition were 10.9% in 21 patients with eventual grade 2 necrosis, and 0% in 31 patients with grade 3 (P=0.038). Median costs of single RFA, repeated RFA, and surgery were yen849,900, yen1,086,000, and yen1,745,100, respectively. Additional ablation reduced local recurrence by 20.7% at the cost of yen236,100.


CONCLUSIONS
Cost-effectiveness of RFA in the treatment of small HCC was superior to that of surgery.
Ikeda
Kenji
K
Department of Gastroenterology, Toranomon Hospital, Okinaka Memorial Institute for Medical Research, Toranomon 2-2-2, Minato-ku 105-8470, Tokyo, Japan.
Kobayashi
Masahiro
M
Saitoh
Satoshi
S
Someya
Takashi
T
Hosaka
Tetsuya
T
Sezaki
Hitomi
H
Suzuki
Yoshiyuki
Y
Suzuki
Fumitaka
F
Akuta
Norio
N
Arase
Yasuji
Y
Kumada
Hiromitsu
H
Matsuda
Masamichi
M
Hashimoto
Masaji
M
Watanabe
Goro
G