Cost-Effectiveness Analysis of Interventional Liver-Directed Therapies for a Single,Small Hepatocellular Carcinoma in Liver Transplant Candidates |
| |
| Institution: | 1. Department of Radiology and Biomedical Imaging, Stanford University, San Francisco, California;2. Department of General Hepatology and Liver Transplantation, University of California, Stanford University, San Francisco, California;3. Department of Gastroenterology & Hepatology, Stanford University, San Francisco, California;1. Department of Radiology, Memorial Sloan Kettering Cancer Center, 1275 York Ave, New York, NY 10065;2. Weill Cornell Medical College, New York, NY;3. Department of Surgery, Memorial Sloan Kettering Cancer Center, New York, NY;1. Division of Interventional Radiology, Department of Radiology, Weill Cornell Medicine, New York, New York;2. Department of Population Health Sciences, Weill Cornell Medicine, New York, New York;3. Interventional Radiology, University of Pittsburgh Medical Center, Pittsburgh, Pennsylvania;4. Division of Interventional Radiology, University of Alabama at Birmingham, Birmingham, Alabama;5. Department of Imaging Sciences, University of Rochester, Rochester, New York;6. Rhode Island Vascular Institute, Providence, Rhode Island;7. Division of Interventional Radiology, Cambria-Somerset Radiology and Nuclear Medicine Group, Johnstown, Pennsylvania;8. Department of Radiology and Imaging Sciences, National Institutes of Health Clinical Center, Bethesda, Maryland;9. Interventional Radiology and Diagnostic Radiology, Beth Israel Deaconess Medical Center, Boston, Massachusetts;10. Department of Radiology, University of Utah Health, Salt Lake City, Utah;11. Division of Interventional Radiology, Massachusetts General Hospital, Boston, Massachusetts;12. Interventional Radiology, Advent Health Medical Group, Central Florida;13. Ajax Health, Menlo Park, California;14. Department of Radiology, Stanford University, Stanford, California;15. Department of Radiology, VA Palo Alto Health Care System, Palo Alto, California;1. Department of Diagnostic Radiology, Tan Tock Seng Hospital, 11 Jalan Tan Tock Seng, Singapore 308433, Singapore;2. Department of General Surgery, Tan Tock Seng Hospital, 11 Jalan Tan Tock Seng, Singapore 308433, Singapore;1. German Aortic Center, University Heart Center, University Hospital Hamburg-Eppendorf, Hamburg;2. Department of Vascular and Endovascular Surgery, Paracelsus Medical University, Nürnberg, Germany;3. Division of Vascular and Endovascular Surgery, Advanced Endovascular Aortic Research Program, Mayo Clinic, Rochester, Minnesota;4. Department of Radiology, Royal Liverpool University Hospital, Liverpool, United Kingdom;5. Department of Vascular Surgery, Faculty of Medicine, Mansoura University, Mansoura, Egypt |
| |
| Abstract: | PurposeTo assess the cost effectiveness of 3 main locoregional therapies (LRTs) (transarterial chemoembolization TACE], transarterial radioembolization TARE], and percutaneous ablation) as bridging therapy.Materials and MethodsA cost-effectiveness analysis was performed comparing the 3 LRTs for patients with a single hepatocellular carcinoma (HCC) with a diameter of 3 cm or less over a 5-year time horizon from a payer’s perspective. The clinical courses, including transplantation, decompensation resulting in delisting, and the need for a second LRT, were based on data from the United Network for Organ Sharing (2016–2019). Costs and effectiveness were measured in U.S. dollars and quality-adjusted life-years, respectively. Probabilistic and deterministic sensitivity analyses were performed.ResultsA total of 2,594, 1,576, and 903 patients underwent TACE, ablation, and TARE, respectively. Ablation was the dominant strategy, with the lowest expected cost and highest effectiveness. The probabilistic sensitivity analysis demonstrated that ablation was the most cost-effective strategy in 93.9% of simulations. A subgroup analysis was performed for different wait times, with ablation remaining the most cost-effective strategy. The sensitivity analysis showed that ablation was most effective if the risk of waitlist dropout was less than 2.00% and the rate of transplantation was more than 15.1% quarterly. TARE was most effective if the risk of dropout was less than 1.19% and the rate of transplantation was more than 24.0%. TACE was most effective if the risk of dropout was less than 1.01% and the rate of transplantation was more than 45.7%. Ablation remained the most cost-effective modality until its procedural cost was more than $34,843.ConclusionsAblation is the most cost-effective bridging strategy for patients with a single, small (≤3 cm) HCC prior to liver transplantation. The conclusion remained robust in multiple sensitivity analyses. |
| |
| Keywords: | BCLC"} {"#name":"keyword" "$":{"id":"kwrd0015"} "$$":[{"#name":"text" "_":"Barcelona Clinic Liver Cancer HCC"} {"#name":"keyword" "$":{"id":"kwrd0025"} "$$":[{"#name":"text" "_":"hepatocellular carcinoma LRT"} {"#name":"keyword" "$":{"id":"kwrd0035"} "$$":[{"#name":"text" "_":"locoregional therapy OPTN"} {"#name":"keyword" "$":{"id":"kwrd0045"} "$$":[{"#name":"text" "_":"Organ Procurement and Transplantation Network QALY"} {"#name":"keyword" "$":{"id":"kwrd0055"} "$$":[{"#name":"text" "_":"quality-adjusted life-year RF"} {"#name":"keyword" "$":{"id":"kwrd0065"} "$$":[{"#name":"text" "_":"radiofrequency TACE"} {"#name":"keyword" "$":{"id":"kwrd0075"} "$$":[{"#name":"text" "_":"transarterial chemoembolization TARE"} {"#name":"keyword" "$":{"id":"kwrd0085"} "$$":[{"#name":"text" "_":"transarterial radioembolization UNOS"} {"#name":"keyword" "$":{"id":"kwrd0095"} "$$":[{"#name":"text" "_":"United Network for Organ Sharing WTP"} {"#name":"keyword" "$":{"id":"kwrd0105"} "$$":[{"#name":"text" "_":"willingness to pay |
| 本文献已被 ScienceDirect 等数据库收录！ |
|
