title: Cost-effectiveness of hepatic resection versus percutaneous radiofrequency ablation for early hepatocellular carcinoma.
abstract: OBJECTIVE
  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: 3996 patients underwent resection and 4424 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 provider perspective. A Monte Carlo probabilistic sensitivity analysis was used to estimate outcomes with distribution samples of 1000 patients for each treatment arm.
  
  
  RESULTS
  In a 10-year perspective, for very early HCC (single nodule <2 cm) 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 3-5 cm, resection provided better life-expectancy and was more cost-effective than RFA, at a willingness-to-pay above €4200 per quality-adjusted life-year. In the presence of two or three nodules ≤3 cm, 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 ≤3 cm, 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.
authors.affiliation: Liver and Multiorgan Transplant Unit, S. Orsola-Malpighi Hospital, Alma Mater Studiorum - University of Bologna, Bologna, Italy.
authors.forename: Alessandro
authors.initials: A
authors.lastname: Cucchetti
authors.forename: Fabio
authors.initials: F
authors.lastname: Piscaglia
authors.forename: Matteo
authors.initials: M
authors.lastname: Cescon
authors.forename: Antonio
authors.initials: A
authors.lastname: Colecchia
authors.forename: Giorgio
authors.initials: G
authors.lastname: Ercolani
authors.forename: Luigi
authors.initials: L
authors.lastname: Bolondi
authors.forename: Antonio D
authors.initials: AD
authors.lastname: Pinna
mesh_terms: D006528:Carcinoma, Hepatocellular / Q000401:mortality / Q000473:pathology / Q000601:surgery*; D017115:Catheter Ablation / Q000191:economics* / Q000379:methods; D003362:Cost-Benefit Analysis; D006498:Hepatectomy / Q000191:economics* / Q000379:methods; D006801:Humans; D008017:Life Expectancy; D008113:Liver Neoplasms / Q000401:mortality / Q000473:pathology / Q000601:surgery*; D008390:Markov Chains; D009010:Monte Carlo Method; D019057:Quality-Adjusted Life Years; D000078702:Radiofrequency Therapy
keywords: CE; Cirrhosis; Cost-effectiveness; HCC; HR; Hepatic resection; Hepatocellular carcinoma; Meta-analysis; NHS; National Healthcare System; QALY; RFA; RR; Radiofrequency ablation; WTP; cost-effectiveness; hepatic resection; hepatocellular carcinoma; quality-adjusted life-year; radiofrequency ablation; relative risk; willingness-to-pay