Hepatocellular adenoma: cost-effectiveness of different treatment strategies.
OBJECTIVE
To determine the effectiveness, costs, and cost-effectiveness of strategies for the management of hepatocellular adenoma (HA) in women who are otherwise healthy.


METHODS
A Markov model was developed to estimate the quality-adjusted life expectancy (in quality-adjusted life-years [QALYs]), lifetime costs (in 2007 U.S. dollars), and net health benefits (QALY equivalent) of surgery, transarterial embolization (TAE), radiofrequency ablation (RFA), and watchful waiting. Model parameters and their distributions were derived from the literature and the hospital database.


RESULTS
In patients with HA tumors suitable for RFA, RFA had the highest effectiveness (23.89 QALYs) and lowest costs ($2965). The treatment decision was sensitive to RFA-related mortality. In patients with tumors unsuitable for RFA, watchful waiting combined with TAE in cases of hemorrhage had the highest effectiveness (23.83 QALYs) and lowest costs ($8493). The treatment decision was sensitive to probability of tumor growth, probability of hemorrhage, and hemorrhage-related mortality.


CONCLUSIONS
According to the model results, the most favorable treatment strategy for patients with small HAs was RFA. In patients with HA unsuitable for RFA, watchful waiting was the optimal strategy.
van der Sluis
Frederik Jan Fabian
FJ
Department of Surgery, Erasmus University Medical Centre Rotterdam, Dr Molewaterplein 50, Room Ee 21-40, 3015 GE Rotterdam, the Netherlands.
Bosch
Johanna L
JL
Terkivatan
Türkan
T
de Man
Robert A
RA
Ijzermans
Jan N M
JN
Hunink
M G Myriam
MG
D000236:Adenoma / Q000191:economics / Q000628:therapy*; D017115:Catheter Ablation / Q000191:economics*; D003362:Cost-Benefit Analysis; D004621:Embolization, Therapeutic / Q000191:economics; D005260:Female; D017048:Health Care Costs; D006801:Humans; D007902:Length of Stay / Q000706:statistics & numerical data; D008017:Life Expectancy; D008113:Liver Neoplasms / Q000191:economics / Q000628:therapy*; D008297:Male; D008390:Markov Chains; D019057:Quality-Adjusted Life Years