W1775 Significance of Perihepatic Lymphadenopathy in Patients with Cirrhosis Undergoing Liver Transplantation

Abstract

Background: While 5 year survival and tumor progression after radiofrequency ablation (RFA) and transcatheter arterial chemoembolization (TACE) for hepatocellular carcinoma (HCC) have been studied, data on cost-effectiveness (CE) comparing these 2 procedures are lacking. Using Markov models, we assessed whether RFA or TACE was more costeffective. Methods: Clinical and financial data were obtained for RFA or TACE patients from June 2006 June 2008. Patient's age, gender, tumor size, treatment course, and direct costs were recorded. Costs of complications were excluded when entering direct procedure costs into the model. Probabilities of tumor progression after RFA or TACE were obtained from published studies. Data was analyzed using TreeAge Pro 2008 Suite 1.2 (TreeAge Software Inc, Williamstown, MA). A Markov model was developed to compare costs and survival outcomes over 5 years, and sensitivity analyses assessed whether model results were stable within plausible ranges of the estimated components. Results: 95 patients were evaluated, 16 received RFA (age = 62.5 ± 11.4 yrs; 10M), and 79 received TACE (age = 64.4 ± 10.6 yrs; 58M). Average tumor size for RFA was 2.23 x 1.84 cm ± 0.96 x 0.83 cm, while for TACE was 3.02 x 2.43 cm ± 1.38 x 1.31 cm. The baseline estimate of the probability of tumor progression after RFA was 0.056 (range = 0.036-0.06) and with TACE was 0.43 (range = 0.19-0.68). Average cost of RFA is $3133 (range=$1760 to $8063) while TACE is $6828 (range=$6687 to $7132). The incremental cost-effectiveness ratio average is $2908 (range= $2086 to $3730). Over 5 years, RFA direct costs were $9,373 with 4.54 life years obtained, while direct costs for TACE were $15,791 with 1.87 life years obtained. Results from the model were not sensitive to any estimated component. Conclusions: Identifying direct costs and overall effects of non-surgical therapies are important factors to consider in managing HCC. Our analysis indicates that RFA is the most cost-effective strategy across all ranges of direct costs when compared to TACE. While RFA had a wider range of direct costs, results from the Markov model demonstrate that RFA is more cost-effective than TACE for any plausible range of estimates for cost and tumor progression. Future randomized controlled trials are needed to compare CE of all non-surgical therapies for HCC.