Purpose: Patients with early stage hepatocellular carcinoma (HCC) are candidates for potentially curative therapies of surgical resection (SR), radiofrequency ablation (RFA), or liver transplantation (LT) which have demonstrated survival benefit. Using a net-benefit regression approach with linked health administrative data, we evaluated the cost-effectiveness of potentially curative therapies from a healthcare payer’s perspective in a Canadian setting.
Method: We identified a cohort of patients diagnosed with HCC in the Ontario Cancer Registry between January 1, 2002 and December 31, 2008. We excluded patients who received alternative treatments for advanced stage of HCC such as transarterial chemoembolization, sorafenib, chemotherapy, or palliative care. Cost estimates are direct healthcare costs and the effectiveness is measured in years of life lost (YLL) due to HCC. Cost and effect data are combined with assumptions about willingness-to-pay (WTP) to produce individual-level net-benefit. The independent variables include the type of curative treatment, index year, age, gender, birth location, income quintile, rurality, Charlson-Deyo Comorbidity Index, propensity score, and interaction terms.
Result: Among a total of 1,348 patients diagnosed with HCC during 2002-2008, 17%, 14%, and 8% received SR, LT and RFA only, with mean YLL of 6.5, 5.2, and 8.0, respectively; 2-3% received a combination of curative therapies with 3.5-4.7 YLL; and 1% received triple curative therapy with 3.1 YLL. The majority (53%) of patients who did not receive any treatment had a mean YLL of 13.2. Estimates of the total cost over the study period for SR, LT, and RFA were 2010 Canadian dollars $130,369, $233,642, and $59,659, respectively. Over the 7-year time frame, when compared to no treatment: RFA was cost-effective, with a probability ranging from 60% to ~100% at a WTP/YLL from $0 to $5,000 and above; LT was cost-effective, with a probability ranging from 55% to 78% at a WTP/YLL from $200,000 to $500,000; however, SR was not cost-effective at a WTP/YLL up to $5,000,000. When compared to SR, RFA was more cost-effective, with a reduction in probability of cost-effectiveness from ~100% to 93% at WTP/YLL up to $200,000.
Conclusion: RFA appears to be the most cost-effective curative treatment for patients with potential early stage of HCC in a Canadian setting. Results from this study may potentially inform policy makers, with an aim toward improving efficiency and value in healthcare.
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