Cost Analysis of Percutaneous Segmentectomy Versus Chemoembolisation and Radioembolisation in Hepatocellular Carcinoma: A Retrospective Multicentre Cohort Study.

PURPOSE: To compare the costs of percutaneous segmentectomy, a single-session combination of transarterial embolisation and microwave ablation, against chemoembolisation and radioembolisation for hepatocellular carcinoma.

MATERIALS AND

METHODS

Retrospective cost analysis of 66 patients treated with percutaneous segmentectomy at five Italian centres, using bottom-up micro-costing. Comparator costs were derived from published Italian per-session costs multiplied by mean sessions per patient, and survival from published curves. A partitioned survival model estimated life-years and incremental net monetary benefit at 50,000 euros per life-year.

RESULTS

Procedural cost per treated patient was 6331 euros for percutaneous segmentectomy, 9792 euros for chemoembolisation (mean 2.94 sessions), and 21,673 euros for radioembolisation (1.52 sessions). At 24 months, percutaneous segmentectomy had lower total cost and a small life-year deficit (incremental cost-effectiveness ratio approximately 70,800 euros per life-year versus chemoembolisation and 57,500 versus radioembolisation, both above threshold). This life-year-adjusted advantage reversed versus chemoembolisation, and became neutral versus radioembolisation, in a worst-case sensitivity analysis, and reversed against both when transplantation costs for the eight transplanted patients (19%) were attributed to percutaneous segmentectomy alone.

CONCLUSION

In this exploratory analysis, percutaneous segmentectomy appeared to have a lower procedural cost per treated patient than chemoembolisation and radioembolisation, mainly because it is delivered in a single session. However, because costing routes, cohorts, and survival sources were not equivalent and the life-year-adjusted comparison was not robust, no formal cost superiority can be established. These hypothesis-generating findings require confirmation in prospective, matched studies.

LEVEL OF EVIDENCE: Level 4, Retrospective Cohort Study with Historical Comparators.