title: Cost-effectiveness of Stereotactic Body Radiation Therapy versus Radiofrequency Ablation for Hepatocellular Carcinoma: A Markov Modeling Study.
abstract: Purpose To assess the cost-effectiveness of stereotactic body radiation therapy (SBRT) versus radiofrequency ablation (RFA) for patients with inoperable localized hepatocellular carcinoma (HCC) who are eligible for both SBRT and RFA. Materials and Methods A decision-analytic Markov model was developed for patients with inoperable, localized HCC who were eligible for both RFA and SBRT to evaluate the cost-effectiveness of the following treatment strategies: (a) SBRT as initial treatment followed by SBRT for local progression (SBRT-SBRT), (b) RFA followed by RFA for local progression (RFA-RFA), (c) SBRT followed by RFA for local progression (SBRT-RFA), and (d) RFA followed by SBRT for local progression (RFA-SBRT). Probabilities of disease progression, treatment characteristics, and mortality were derived from published studies. Outcomes included health benefits expressed as discounted quality-adjusted life years (QALYs), costs in U.S. dollars, and cost-effectiveness expressed as an incremental cost-effectiveness ratio. Deterministic and probabilistic sensitivity analysis was performed to assess the robustness of the findings. Results In the base case, SBRT-SBRT yielded the most QALYs (1.565) and cost $197 557. RFA-SBRT yielded 1.558 QALYs and cost $193 288. SBRT-SBRT was not cost-effective, at $558 679 per QALY gained relative to RFA-SBRT. RFA-SBRT was the preferred strategy, because RFA-RFA and SBRT-RFA were less effective and more costly. In all evaluated scenarios, SBRT was preferred as salvage therapy for local progression after RFA. Probabilistic sensitivity analysis showed that at a willingness-to-pay threshold of $100 000 per QALY gained, RFA-SBRT was preferred in 65.8% of simulations. Conclusion SBRT for initial treatment of localized, inoperable HCC is not cost-effective. However, SBRT is the preferred salvage therapy for local progression after RFA.©RSNA, 2017 Online supplemental material is available for this article.
authors.affiliation: From the Department of Radiation Oncology (E.L.P., B.Y.D., M.G., D.A.M., A.C.K., D.T.C.), Centers for Health Policy and Primary Care and Outcomes Research (K.L., D.K.O., J.G.F.), and Department of Radiology (N.K.), Stanford University School of Medicine, Stanford University Medical Center, 875 Blake Wilbur Dr, Stanford, CA 94305-5847; Department of Radiation Oncology, University of Michigan Medical School, Ann Arbor, Mich (D.R.W., M.F.); and Veteterans Affairs Palo Alto Health Care System, Palo Alto, Calif (D.K.O.).
authors.forename: Erqi L
authors.initials: EL
authors.lastname: Pollom
authors.affiliation: From the Department of Radiation Oncology (E.L.P., B.Y.D., M.G., D.A.M., A.C.K., D.T.C.), Centers for Health Policy and Primary Care and Outcomes Research (K.L., D.K.O., J.G.F.), and Department of Radiology (N.K.), Stanford University School of Medicine, Stanford University Medical Center, 875 Blake Wilbur Dr, Stanford, CA 94305-5847; Department of Radiation Oncology, University of Michigan Medical School, Ann Arbor, Mich (D.R.W., M.F.); and Veteterans Affairs Palo Alto Health Care System, Palo Alto, Calif (D.K.O.).
authors.forename: Kyueun
authors.initials: K
authors.lastname: Lee
authors.affiliation: From the Department of Radiation Oncology (E.L.P., B.Y.D., M.G., D.A.M., A.C.K., D.T.C.), Centers for Health Policy and Primary Care and Outcomes Research (K.L., D.K.O., J.G.F.), and Department of Radiology (N.K.), Stanford University School of Medicine, Stanford University Medical Center, 875 Blake Wilbur Dr, Stanford, CA 94305-5847; Department of Radiation Oncology, University of Michigan Medical School, Ann Arbor, Mich (D.R.W., M.F.); and Veteterans Affairs Palo Alto Health Care System, Palo Alto, Calif (D.K.O.).
authors.forename: Ben Y
authors.initials: BY
authors.lastname: Durkee
authors.affiliation: From the Department of Radiation Oncology (E.L.P., B.Y.D., M.G., D.A.M., A.C.K., D.T.C.), Centers for Health Policy and Primary Care and Outcomes Research (K.L., D.K.O., J.G.F.), and Department of Radiology (N.K.), Stanford University School of Medicine, Stanford University Medical Center, 875 Blake Wilbur Dr, Stanford, CA 94305-5847; Department of Radiation Oncology, University of Michigan Medical School, Ann Arbor, Mich (D.R.W., M.F.); and Veteterans Affairs Palo Alto Health Care System, Palo Alto, Calif (D.K.O.).
authors.forename: Madeline
authors.initials: M
authors.lastname: Grade
authors.affiliation: From the Department of Radiation Oncology (E.L.P., B.Y.D., M.G., D.A.M., A.C.K., D.T.C.), Centers for Health Policy and Primary Care and Outcomes Research (K.L., D.K.O., J.G.F.), and Department of Radiology (N.K.), Stanford University School of Medicine, Stanford University Medical Center, 875 Blake Wilbur Dr, Stanford, CA 94305-5847; Department of Radiation Oncology, University of Michigan Medical School, Ann Arbor, Mich (D.R.W., M.F.); and Veteterans Affairs Palo Alto Health Care System, Palo Alto, Calif (D.K.O.).
authors.forename: Daniel A
authors.initials: DA
authors.lastname: Mokhtari
authors.affiliation: From the Department of Radiation Oncology (E.L.P., B.Y.D., M.G., D.A.M., A.C.K., D.T.C.), Centers for Health Policy and Primary Care and Outcomes Research (K.L., D.K.O., J.G.F.), and Department of Radiology (N.K.), Stanford University School of Medicine, Stanford University Medical Center, 875 Blake Wilbur Dr, Stanford, CA 94305-5847; Department of Radiation Oncology, University of Michigan Medical School, Ann Arbor, Mich (D.R.W., M.F.); and Veteterans Affairs Palo Alto Health Care System, Palo Alto, Calif (D.K.O.).
authors.forename: Daniel R
authors.initials: DR
authors.lastname: Wahl
authors.affiliation: From the Department of Radiation Oncology (E.L.P., B.Y.D., M.G., D.A.M., A.C.K., D.T.C.), Centers for Health Policy and Primary Care and Outcomes Research (K.L., D.K.O., J.G.F.), and Department of Radiology (N.K.), Stanford University School of Medicine, Stanford University Medical Center, 875 Blake Wilbur Dr, Stanford, CA 94305-5847; Department of Radiation Oncology, University of Michigan Medical School, Ann Arbor, Mich (D.R.W., M.F.); and Veteterans Affairs Palo Alto Health Care System, Palo Alto, Calif (D.K.O.).
authors.forename: Mary
authors.initials: M
authors.lastname: Feng
authors.affiliation: From the Department of Radiation Oncology (E.L.P., B.Y.D., M.G., D.A.M., A.C.K., D.T.C.), Centers for Health Policy and Primary Care and Outcomes Research (K.L., D.K.O., J.G.F.), and Department of Radiology (N.K.), Stanford University School of Medicine, Stanford University Medical Center, 875 Blake Wilbur Dr, Stanford, CA 94305-5847; Department of Radiation Oncology, University of Michigan Medical School, Ann Arbor, Mich (D.R.W., M.F.); and Veteterans Affairs Palo Alto Health Care System, Palo Alto, Calif (D.K.O.).
authors.forename: Nishita
authors.initials: N
authors.lastname: Kothary
authors.affiliation: From the Department of Radiation Oncology (E.L.P., B.Y.D., M.G., D.A.M., A.C.K., D.T.C.), Centers for Health Policy and Primary Care and Outcomes Research (K.L., D.K.O., J.G.F.), and Department of Radiology (N.K.), Stanford University School of Medicine, Stanford University Medical Center, 875 Blake Wilbur Dr, Stanford, CA 94305-5847; Department of Radiation Oncology, University of Michigan Medical School, Ann Arbor, Mich (D.R.W., M.F.); and Veteterans Affairs Palo Alto Health Care System, Palo Alto, Calif (D.K.O.).
authors.forename: Albert C
authors.initials: AC
authors.lastname: Koong
authors.affiliation: From the Department of Radiation Oncology (E.L.P., B.Y.D., M.G., D.A.M., A.C.K., D.T.C.), Centers for Health Policy and Primary Care and Outcomes Research (K.L., D.K.O., J.G.F.), and Department of Radiology (N.K.), Stanford University School of Medicine, Stanford University Medical Center, 875 Blake Wilbur Dr, Stanford, CA 94305-5847; Department of Radiation Oncology, University of Michigan Medical School, Ann Arbor, Mich (D.R.W., M.F.); and Veteterans Affairs Palo Alto Health Care System, Palo Alto, Calif (D.K.O.).
authors.forename: Douglas K
authors.initials: DK
authors.lastname: Owens
authors.affiliation: From the Department of Radiation Oncology (E.L.P., B.Y.D., M.G., D.A.M., A.C.K., D.T.C.), Centers for Health Policy and Primary Care and Outcomes Research (K.L., D.K.O., J.G.F.), and Department of Radiology (N.K.), Stanford University School of Medicine, Stanford University Medical Center, 875 Blake Wilbur Dr, Stanford, CA 94305-5847; Department of Radiation Oncology, University of Michigan Medical School, Ann Arbor, Mich (D.R.W., M.F.); and Veteterans Affairs Palo Alto Health Care System, Palo Alto, Calif (D.K.O.).
authors.forename: Jeremy
authors.initials: J
authors.lastname: Goldhaber-Fiebert
authors.affiliation: From the Department of Radiation Oncology (E.L.P., B.Y.D., M.G., D.A.M., A.C.K., D.T.C.), Centers for Health Policy and Primary Care and Outcomes Research (K.L., D.K.O., J.G.F.), and Department of Radiology (N.K.), Stanford University School of Medicine, Stanford University Medical Center, 875 Blake Wilbur Dr, Stanford, CA 94305-5847; Department of Radiation Oncology, University of Michigan Medical School, Ann Arbor, Mich (D.R.W., M.F.); and Veteterans Affairs Palo Alto Health Care System, Palo Alto, Calif (D.K.O.).
authors.forename: Daniel T
authors.initials: DT
authors.lastname: Chang
mesh_terms: D006528:Carcinoma, Hepatocellular / Q000191:economics* / Q000401:mortality*; D017115:Catheter Ablation / Q000191:economics* / Q000401:mortality / Q000706:statistics & numerical data; D003198:Computer Simulation; D003362:Cost-Benefit Analysis / Q000191:economics; D017048:Health Care Costs / Q000706:statistics & numerical data; D006801:Humans; D008113:Liver Neoplasms / Q000191:economics* / Q000401:mortality*; D008390:Markov Chains; D018803:Models, Economic; D011183:Postoperative Complications / Q000191:economics / Q000401:mortality; D015995:Prevalence; D011379:Prognosis; D016016:Proportional Hazards Models; D011832:Radiation Injuries / Q000191:economics / Q000401:mortality; D016634:Radiosurgery / Q000191:economics* / Q000401:mortality / Q000706:statistics & numerical data; D015203:Reproducibility of Results; D018570:Risk Assessment / Q000379:methods; D012680:Sensitivity and Specificity; D015996:Survival Rate; D014481:United States / Q000453:epidemiology