Cost-Effectiveness Analysis of Resection, Ablation and Radiation Segmentectomy for Solitary Hepatocellular Carcinoma ≤3 cm from a U.S. Payor's Perspective.

PURPOSE: To perform a cost-effectiveness analysis comparing liver resection, percutaneous thermal ablation (TA), and radiation segmentectomy (RS) for solitary hepatocellular carcinoma (HCC) ≤3 cm with curative intent.

METHODS: A cost-effectiveness analysis was performed comparing resection, TA, and RS for patients with solitary HCC ≤3 cm using a time horizon from a U.S. payor's perspective over 5 years using Markov modeling. Clinical outcomes were pooled from 4 comparative studies between ablation and resection. The outcomes after RS were pooled using 3 published studies and institutional data. Base case calculation and probabilistic and deterministic sensitivity analyses were performed.

RESULTS: Base case calculation showed TA to be the most cost-effective strategy. RS had the highest effectiveness (RS, 3.31 quality-adjusted life years [QALY]; 95% CI, 3.305-3.315; resection, 3.29 QALY; 95% CI, 3.286-3.294), and TA had the lower effectiveness of 3.20 QALY (95% CI, 3.196-3.204). Probabilistic sensitivity analysis showed ablation to be the most cost-effective strategy in 68.7% of iterations; resection, 20.6%; and RS, 10.8%. TA was the most cost-effective if its quarterly distant recurrence risk was lower than 2.8% (base case, 2.5%). Sensitivity analyses varying procedural costs showed resection to be cost-effective when its cost was below $26,779 or RS to be cost-effective when its cost was lower than $11,857.

CONCLUSIONS: Ablation was the most cost-effective treatment of curative intent for patients with solitary HCC ≤3 cm, with RS having the highest effectiveness but overall higher cost driven by large proportion of surviving patients requiring routine follow-up care.