Cost-benefit analysis of hepatic resection, radiofrequency ablation and liver transplantation in small hepatocellular carcinoma

ABSTRACT

Objective

The aim of the present study was to evaluate the cost-effectiveness ratio of surgical treatment options for small hepatocellular carcinoma (SHC) by using the decision tree model and providing a reference for the clinical therapeutic decisions for SHC.

Methods

The data of 719 cases with SHC in the BCLC 0-A who were treated in the past were collected. The survival duration and treatment cost of patients in each experimental group after hepatic resection (HR), radiofrequency ablation (RFA), and orthotopic liver transplantation (OLT) were statistically analyzed.

Results

For SHC with a diameter of less than 3.0 cm, HR, RFA, and OLT had similar cost-effectiveness ratios. OLT could achieve a longer life expectancy, but it was greatly affected by the dropout rate while waiting for the liver donor. RFA was preferred when the willingness to pay (WTP) < 2,5000 RMB/QALY, OLT was preferred when WTP > 75,000 RMB/QALY, and HR was preferred when WTP was between the two.

Expert opinion

HR in SHC with OLT had the longest life expectancy, but due to the limitations of organ sources, OLT was the preferred treatment option when the WTP was large enough.

KEYWORDS:

• Small hepatocellular carcinoma
• Hepatic resection
• Radiofrequency ablation
• Orthotopic liver transplantation
• Markov model
• Decision tree
• Willingness-to-pay
• Cost-effectiveness analysis

Author contributions

Xue-Li Jiao and Jian-Feng Chen conceived the idea and conceptualised the study. Shou-Chuan Li collected the data. Shou-Chuan Li and Lei Hao analysed the data. Ting-Gang Wang used the software. Xue-Li Jiao and Jian-Feng Chen drafted the manuscript, then Xue-Li Jiao and Jian-Feng Chen reviewed the manuscript. All authors read and approved the final draft.

We agreed to be personally accountable for the author’s own cofntributions and to ensure that questions related to the accuracy or integrity of any part of the work, even ones in which the author was not personally involved, are appropriately investigated, resolved, and the resolution documented in the literature.

Declaration of interest

The authors have no relevant affiliations or financial involvement with any organization or entity with a financial interest in or financial conflict with the subject matter or materials discussed in the manuscript. This includes employment, consultancies, honoraria, stock ownership or options, expert testimony, grants or patents received or pending, or royalties.

Reviewer Disclosures

Peer reviewers on this manuscript have no relevant financial or other relationships to disclose

Additional information

Funding

This paper was funded by the China Postdoctoral Science Foundation (No. 2013M542516).