Hepatocellular Adenoma: Cost-effectiveness of Different Treatment Strategies

If the preliminary clinical research on which our model was based proves to be reliable, our results will suggest that costs could be reduced by treating small hepatocellular adenomas with percutaneous radiofrequency ablation—provided the tumor is suitable for this procedure.

Purpose

To determine the effectiveness, costs, and cost-effectiveness of strategies for the management of hepatocellular adenoma (HA) in women who are otherwise healthy.

Materials and Methods

A Markov model was developed to estimate the quality-adjusted life expectancy (in quality-adjusted life-years [QALYs]), lifetime costs (in 2007 U.S. dollars), and net health benefits (QALY equivalent) of surgery, transarterial embolization (TAE), radiofrequency ablation (RFA), and watchful waiting. Model parameters and their distributions were derived from the literature and the hospital database.

Results

In patients with HA tumors suitable for RFA, RFA had the highest effectiveness (23.89 QALYs) and lowest costs ($2965). The treatment decision was sensitive to RFA-related mortality. In patients with tumors unsuitable for RFA, watchful waiting combined with TAE in cases of hemorrhage had the highest effectiveness (23.83 QALYs) and lowest costs ($8493). The treatment decision was sensitive to probability of tumor growth, probability of hemorrhage, and hemorrhage-related mortality.

Conclusion

According to the model results, the most favorable treatment strategy for patients with small HAs was RFA. In patients with HA unsuitable for RFA, watchful waiting was the optimal strategy.

© RSNA, 2009

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Article History

Received December 14, 2008; revision requested January 30, 2009; revision received February 20; accepted March 11; final version accepted March 24.
Published in print: Sept 2009