title: Interventional radiologic treatment of hepatocellular carcinoma-a cost analysis from the payer perspective.
abstract: OBJECTIVE
  To determine whether there is a cost advantage for one of the three commonly performed interventional radiology (IR) procedures (chemoembolization, selective internal radiation therapy [SIRT], radiofrequency ablation [RFA]) in the treatment of hepatocellular carcinoma (HCC).
  
  
  METHODS
  A cost analysis from the payer perspective was performed. Primary data were collected from a university hospital, and sensitivity testing was done by comparing coding information obtained at two other tertiary care medical facilities. Medicare allowable reimbursements were used to estimate costs. Decision analytic models using decision tree analysis and Monte Carlo simulations were used to compare alternatives. Simulations were performed comparing all three procedures, followed by a two-way comparison of chemoembolization and SIRT.
  
  
  RESULTS
  Simple decision tree analyses showed that RFA was less expensive compared with chemoembolization and SIRT. Monte Carlo simulations showed average reimbursements for each of the three procedures that was largely dependent on the number of repeat procedures required ($9,362 vs $30,107 vs $35,629 for RFA, chemoembolization, and SIRT; P < .001). When comparing only chemoembolization and SIRT, chemoembolization was the lower cost strategy in most scenarios, but SIRT was lower in cost in more than one-third of the simulations.
  
  
  CONCLUSIONS
  RFA was the least costly of the three IR strategies in nearly all scenarios studied in these models. Although chemoembolization was less expensive than SIRT in most instances, Monte Carlo simulation showed a preference for SIRT in more than one-third of all scenarios. Sensitivity analyses showed that the most important variables assessed were the need for repeat procedures.
authors.affiliation: Department of Radiology, University of Colorado, Aurora, CO 80045, USA. Charles.ray@ucdenver.edu
authors.forename: Charles E
authors.initials: CE
authors.lastname: Ray
authors.forename: Catherine
authors.initials: C
authors.lastname: Battaglia
authors.forename: Anne M
authors.initials: AM
authors.lastname: Libby
authors.forename: Allan
authors.initials: A
authors.lastname: Prochazka
authors.forename: Stan
authors.initials: S
authors.lastname: Xu
authors.forename: Brian
authors.initials: B
authors.lastname: Funaki
mesh_terms: D000368:Aged; D006528:Carcinoma, Hepatocellular / Q000000981:diagnostic imaging / Q000191:economics* / Q000628:therapy*; D017115:Catheter Ablation / Q000191:economics*; D016461:Chemoembolization, Therapeutic / Q000191:economics*; D003198:Computer Simulation; D017046:Cost Savings; D003362:Cost-Benefit Analysis; D003661:Decision Support Techniques; D003663:Decision Trees; D017721:Hospital Costs; D006785:Hospitals, University / Q000191:economics*; D006801:Humans; D007349:Insurance, Health, Reimbursement; D008113:Liver Neoplasms / Q000000981:diagnostic imaging / Q000191:economics* / Q000628:therapy*; D008297:Male; D006278:Medicare / Q000191:economics; D018803:Models, Economic; D009010:Monte Carlo Method; D015641:Radiography, Interventional / Q000191:economics*; D011878:Radiotherapy / Q000191:economics; D016896:Treatment Outcome; D014481:United States