Hostname: page-component-586b7cd67f-t7czq Total loading time: 0 Render date: 2024-11-22T21:43:21.283Z Has data issue: false hasContentIssue false
  • English
  • Français

COST-EFFECTIVENESS OF NAVIGATED RADIOFREQUENCY ABLATION FOR HEPATOCELLULAR CARCINOMA IN CHINA

Published online by Cambridge University Press:  16 February 2015

Yizhen Lai ,
Kai Li ,
Junbo Li  and
Sheena Xin Liu
Yizhen Lai
Affiliation:
Harvard School of Public Health
Kai Li
Affiliation:
The Third Affiliated Hospital of Sun Yat-sen University.
Junbo Li
Affiliation:
Philips Research Asia
Sheena Xin Liu
Affiliation:
Philips Research North America, Briarcliff [email protected]
Get access Rights & Permissions [Opens in a new window]

Abstract

Objectives: Real-time virtual sonography (RVS) is a promising navigation technique for percutaneous radiofrequency ablation (RFA) treatment, especially in ablating nodules poorly visualized on conventional ultrasonography (US). However, its cost-effectiveness has not been established. The purpose of this study is to evaluate the cost-effectiveness of RVS navigated RFA (RVS-RFA) relative to US guided RFA (US-RFA) in patients with small hepatocellular carcinoma (HCC) in China, from the modified societal perspective.

Methods: A state-transition Markov model was created using TreeAge Pro™ 2012. The parameters used in the model, including natural history of HCC patients, procedure efficacy and related costs, were obtained from a systematic search of literature through PubMed, EMBASE, and Science Citation Index databases. The simulated cohort was patients with solitary, small HCC (<3 cm in diameter) and Child-Pugh class A or B, whose tumors are poorly visualized in B-mode US but clearly detectable by CT or MRI.

Results: In this cohort of difficult cases, RVS-RFA was a preferred strategy saving 2,467 CNY ($392) throughout the patient's life while gaining additional 1.4 QALYs compared with conventional US guidance. The results were sensitive to the efficacy of US-RFA and RVS-RFA including complete ablation rate and local recurrence rate, the median survival for patients with progressive HCC, the probability of performing RFA for recurrent HCC, and the cost of RVS navigation, disposable needle or hospitalization.

Conclusions: RVS-RFA is a dominant strategy for patients with small HCC unidentifiable in B-mode US, in terms of cost savings and QALYs gained, relative to the conventional US-guided method.

Keywords

Cost-effectivenessReal-time Virtual SonographyHepatocellular CarcinomaRadiofrequency AblationMarkov model
Type
Assessments
Information
International Journal of Technology Assessment in Health Care , Volume 30 , Issue 4 , October 2014 , pp. 400 - 408
Copyright
Copyright © Cambridge University Press 2015 

Access options

Get access to the full version of this content by using one of the access options below. (Log in options will check for institutional or personal access. Content may require purchase if you do not have access.)

References

REFERENCES

1. Bruix, J, Sherman, M. Management of hepatocellular carcinoma: An update. Hepatology. 2011;3:1020–1022.CrossRefGoogle Scholar
2. Goldberg, SN, Grassi, CJ, Cardella, JF, et al. Image-guided tumor ablation: Standardization of terminology and reporting criteria. J Vasc Interv Radiol. 2009;7 (Suppl):S377–S390.CrossRefGoogle Scholar
3. Hirooka, M, Iuchi, H, Kumagi, T, et al. Virtual sonographic radiofrequency ablation of hepatocellular carcinoma visualized on CT but not on conventional sonography. AJR Am J Roentgenol. 2006;5 (Suppl):S255–S260.Google Scholar
4. Rhim, H, Lee, MH, Kim, YS, et al. Planning sonography to assess the feasibility of percutaneous radiofrequency ablation of hepatocellular carcinomas. AJR Am J Roentgenol. 2008;5:1324–1330.Google Scholar
5. Kitada, T, Murakami, T, Kuzushita, N, et al. Effectiveness of real-time virtual sonography-guided radiofrequency ablation treatment for patients with hepatocellular carcinomas. Hepatol Res. 2008;6:565–571.Google Scholar
6. Minami, Y, Kudo, M, Chung, H, et al. Percutaneous radiofrequency ablation of sonographically unidentifiable liver tumors. Feasibility and usefulness of a novel guiding technique with an integrated system of computed tomography and sonographic images. Oncology. 2007;72:111–116.Google Scholar
7. Cho, YK, Kim, JK, Kim, WT, et al. Hepatic resection versus radiofrequency ablation for very early stage hepatocellular carcinoma: A Markov model analysis. Hepatology. 2010;4:1284–1290.Google Scholar
8. Molinari, M, Helton, S. Hepatic resection versus radiofrequency ablation for hepatocellular carcinoma in cirrhotic individuals not candidates for liver transplantation: A Markov model decision analysis. Am J Surg. 2009;3:396–406.Google Scholar
9. Minami, Y, Chung, H, Kudo, M, et al. Radiofrequency ablation of hepatocellular carcinoma: Value of virtual CT sonography with magnetic navigation. AJR Am J Roentgenol. 2008;6:W335–W341.Google Scholar
10. Liu, FY, Yu, XL, Liang, P, et al. Microwave ablation assisted by a real-time virtual navigation system for hepatocellular carcinoma undetectable by conventional ultrasonography. Eur J Radiol. 2012;7:1455–1459.Google Scholar
11. Nakai, M, Sato, M, Sahara, S, et al. Radiofrequency ablation assisted by real-time virtual sonography and CT for hepatocellular carcinoma undetectable by conventional sonography. Cardiovasc Intervent Radiol. 2009;1:62–9.CrossRefGoogle Scholar
12. Lee, MW, Rhim, H, Cha, DI, et al. Percutaneous radiofrequency ablation of hepatocellular carcinoma: Fusion imaging guidance for management of lesions with poor conspicuity at conventional sonography. AJR Am J Roentgenol. 2012;6:1438–1444.Google Scholar
13. Livraghi, T, Goldberg, SN, Lazzaroni, S, et al. Hepatocellular carcinoma: Radio-frequency ablation of medium and large lesions. Radiology. 2000;3:761–768.CrossRefGoogle Scholar
14. Zhou, Y, Zhao, Y, Li, B, et al. Meta-analysis of radiofrequency ablation versus hepatic resection for small hepatocellular carcinoma. BMC Gastroenterol. 2010;10:78.Google Scholar
15. Scaife, CL, Curley, SA. Complication, local recurrence, and survival rates after radiofrequency ablation for hepatic malignancies. Surg Oncol Clin N Am. 2003;1:243–55.CrossRefGoogle Scholar
16. Zhong, Y, Deng, M, Li, M, et al. Abdominal virtual sonography combined with artificial ascite in RFA for HCC of specific sites. Hepatol Int. 2013;7:1–9.Google Scholar
17. Llovet, JM, Vilana, R, Bru, C, et al. Increased risk of tumor seeding after percutaneous radiofrequency ablation for single hepatocellular carcinoma. Hepatology. 2001;5:1124–1129.Google Scholar
18. Mulier, S, Mulier, P, Ni, Y, et al. Complications of radiofrequency coagulation of liver tumours. Br J Surg. 2002;10:1206–1222.Google Scholar
19. de Villa, V, Lo, CM. Liver transplantation for hepatocellular carcinoma in Asia. Oncologist. 2007;11:1321–31.CrossRefGoogle Scholar
20. McLernon, DJ, Dillon, J, Donnan, PT. Health-state utilities in liver disease: A systematic review. Med Decis Making. 2008;4:582–592.CrossRefGoogle Scholar
21. Stein, K, Rosenberg, W, Wong, J. Cost effectiveness of combination therapy for hepatitis C: A decision analytic model. Gut. 2002;2:253–258.Google Scholar
22. Ruggeri, M, Cicchetti, A, Gasbarrini, A. The cost-effectiveness of alternative strategies against HBV in Italy. Health Policy. 2011;1:72–80.Google Scholar
23. Gazelle, GS, McMahon, PM, Beinfeld, MT, et al. Metastatic colorectal carcinoma: Cost-effectiveness of percutaneous radiofrequency ablation versus that of hepatic resection. Radiology. 2004;3:729–739.Google Scholar
24. Radiofrequency Ablation when Hepatocellular Carcinoma can not undergo resection. 2002. http://www.cctv.com/lm/560/31/48169.html (accessed November 17, 2012).Google Scholar
25. Peng, ZW, Lin, XJ, Zhang, YJ, et al. Radiofrequency ablation versus hepatic resection for the treatment of hepatocellular carcinomas 2 cm or smaller: A retrospective comparative study. Radiology. 2012;3:1022–1033.CrossRefGoogle Scholar
26. Guan, ZQ, Dong, ZH, Wang, QH, et al. Cost of chronic hepatitis B infection in China. J Clin Gastroenterol. 2004;10 (Suppl 3):S175–S178.Google Scholar
27. Chen, D, Yao, G, Chen, W. Economic evaluation of peginterferon Alfa-2a and lamivudine in the treatment of HBeAg negative chronic hepatitis B. J Hepatol. 2014;4:1–9.Google Scholar
28. Chen, JQ, Yang, GH, Zhu, Q, et al. An analysis of related factors of cost of inpatients with hepatic carcinoma receiving operative treatment. Chinese Hospitals. 2003;12:1–9.Google Scholar
29. Huang, J, Yan, L, Cheng, Z, et al. A randomized trial comparing radiofrequency ablation and surgical resection for HCC conforming to the Milan criteria. Ann Surg. 2010;6:903–912.CrossRefGoogle Scholar
30. Hung, HH, Chiou, YY, Hsia, CY, et al. Survival rates are comparable after radiofrequency ablation or surgery in patients with small hepatocellular carcinomas. Clin Gastroenterol Hepatol. 2011;1:79–86.Google Scholar
31. Vivarelli, M, Guglielmi, A, Ruzzenente, A, et al. Surgical resection versus percutaneous radiofrequency ablation in the treatment of hepatocellular carcinoma on cirrhotic liver. Ann Surg. 2004;1:102–107.Google Scholar
32. Eichler, HG, Kong, SX, Gerth, WC, et al. Use of cost-effectiveness analysis in health-care resource allocation decision-making: How are cost-effectiveness thresholds expected to emerge? Value Health. 2004;5:518–528.Google Scholar
33. Kawasoe, H, Eguchi, Y, Mizuta, T, et al. Radiofrequency ablation with the real-time virtual sonography system for treating hepatocellular carcinoma difficult to detect by ultrasonography. J Clin Biochem Nutr. 2007;1:66–72.Google Scholar
Supplementary material: File

Lai et al. supplementary material

Supplementary tables and figures

Download Lai et al. supplementary material(File)
File 130.3 KB