SIR 2024
Interventional Oncology
Xiao Wu, MD (she/her/hers)
Resident Physician
University of California, San Francisco
Financial relationships: Full list of relationships is listed on the CME information page.
Parmede Vakil, MD, PhD
Resident
UCSF
Financial relationships: Full list of relationships is listed on the CME information page.
Michael B. Heller, MD
Health System Clinician
University of California, San Francisco
Disclosure information not submitted.
Evan Lehrman, MD, FSIR (he/him/his)
Associate Professor of Clinical Radiology in Interventional Radiology
UCSF
Financial relationships: Full list of relationships is listed on the CME information page.
Nicholas Fidelman, MD
Professor
University Of California San Francisco
Financial relationships: Full list of relationships is listed on the CME information page.
Neil Mehta, MD
Associate Professor
University of California, San Francisco
Disclosure information not submitted.
R. Peter Lokken, MD, MPH, FSIR (he/him/his)
Associate Professor of Clinical Radiology
UCSF Department of Radiology and Biomedical Imaging
Financial relationships: Full list of relationships is listed on the CME information page.
To perform a cost-effectiveness analysis comparing the partial hepatic resection, percutaneous ablation, and radiation segmentectomy (RS) for solitary hepatocellular carcinoma (HCC) ≤ 3 cm with curative intent.
Materials and Methods:
A cost-effectiveness analysis was performed comparing resection, ablation and RS for patients with solitary HCC ≤ 3 cm horizon from a payer’s perspective over 5 years with a cycle length of 3 months. Clinical outcomes after initial treatment included remission, local recurrence/progression or distant intrahepatic or extrahepatic recurrence, pooled from multiple comparative studies between ablation and resection, inversely weighted by variance {1-3}. The outcomes after RS were pooled among the RASER study, Lewandowski et al. and our unpublished institutional data {4-5}. Base case calculation, probabilistic and deterministic sensitivity analyses were performed.
Results:
Hepatic resection was the most cost-effective strategy with the lowest cost and highest effectiveness in base case analysis (Table 1). RS achieved comparable effectiveness (less than 4 days of life in perfect health) but at a higher cost (additional $53,934 per patient). Between the loco-regional therapies, RS achieved 0.11 additional QALY (40 days in perfect life) at an incremental cost of $23,715 with the cost difference smaller than that of the procedural costs. In probabilistic sensitivity analysis, resection was the most cost-effective strategy in 93.78% of the iterations.
Sensitivity analysis showed distant intrahepatic or extrahepatic recurrence risk and procedural cost to have the greatest impact on the conclusion. RS was the most effective strategy when the risk of distant recurrence was lower than 2.09% per 3 months and most cost-effective when the risk was lower than 1.59% (base case 2.27%). When assuming equal risk of distant recurrence, RS achieved the highest effectiveness of 3.25 QALY at an incremental cost of $677, making it more cost-effective than resection. RS was more cost-effective than ablation when its procedure cost was no more than $12,000 higher than ablation.
Conclusion:
Resection was the most cost-effective curative therapy for solitary HCC ≤ 3 cm, with RS being a more cost-effective strategy when the risk of distant recurrence was similar.