ABLATION has been shown to be the most cost-effective treatment for hepatocellular carcinoma in a recently published study. The research, led by Resmi Charalel, Weill Cornell Medicine, New York, USA, showed that this technique had the lowest median procedure cost compared with surgery or transplant.
Previous research has described survival and morbidity differences between treatment options for HCC, which include ablation, surgical resection, and transplant. However, more clarity is needed to understand drivers of each treatment’s costs and any barriers to the delivery of care, according to the team.
Charalel and colleagues conducted a US-based retrospective study using information from the Surveillance, Epidemiology and End Results (SEER)-Medicare database, which included 1,067 beneficiaries diagnosed with early-stage HCC (tumour size equal to or less than 5 cm); of these, 623 underwent ablation, 201 underwent surgery, and 243 received a transplant between January 2009 and December 2016. The investigators track total costs and patient out-of-pocket costs for each procedure as well as any additional care within 30 days and 90 days after the procedure.
The team found that for ablation, resection, and transplant, median index-procedure total cost was USD 6689, USD 25,614, and USD 66,034; index-procedure out-of-pocket cost was USD 1,235, USD 1,650, and USD 1,317; 30-day total cost was USD 9,456, USD 29,754, and USD 69,856; 30-day out-of-pocket cost was USD 1,646, USD 2,208, and USD 3,198; 90-day total cost was USD 14,572, USD 34,984, and USD 88,103; and 90-day out-of-pocket cost was USD 2,138, USD 2,462, and USD 3,876, respectively (all p<0.001). In propensity-matched subgroups, ablation and resection had median index-procedure, 30-day, and 90-day total costs of USD 6690 and USD 25,716, USD 9,995 and USD 30,365, and USD 15,851 and USD 34,455, respectively. In multivariable analysis adjusting for socioeconomic factors, comorbidities, and liver-disease prognostic indicators, surgical treatment (resection or transplant) was predictive of significantly greater costs compared with ablation at all time points.
This study clearly demonstrated the cost-effectiveness of ablation as treatment for HCC, which the team hoped “could help inform future cost-effectiveness analyses”.
Victoria Antoniou, EMJ
Reference
Charalel RA et al. Short-term out-of-pocket and total costs of care after ablation, resection, or transplant for early-stage hepatocellular carcinoma: a national SEER-medicare cost comparison. 2024;DOI: 10.2214/AJR.24.31272.
