Cost Minimization Analysis of Radiofrequency Compared to Laser Thermal Ablation in Patients with Hepatocellular Carcinoma
Abstract
BACKGROUND: Over the last decade of years, minimally invasive techniques have been developed for the treatment of hepatocellular carcinoma and liver metastases. We sought to investigate the health costs associated with the management of patients with hepatocellular carcinoma treated with radiofrequency vs laser thermal ablation and their clinical outcomes.METHODS: We performed a retrospective analysis of the ablations performed in two referral centers in southern Italy, from 2009 to 2013. Resource use was valued by year 2017 official prices, in €. Direct healthcare costs (drugs, visits, tests and hospitalizations) of different ablation techniques were compared. Total costs were analyzed from Italian NHS perspective.
RESULTS: A total of 140 patients were identified. Baseline demographics and clinical outcomes of interest did not differ between the two groups. Patients treated with laser thermal ablation resulted in an expected annually cost savings of 258.9 € per patient, in one-year follow-up healthcare costs compared with radiofrequency. The largest components of annual medical expenditures were attributable to drugs, regardless of the type of ablative technique.
CONCLUSIONS: The ablation using either laser thermal ablation or radiofrequency is equally effective. Laser thermal ablation would carry disposable cost savings as compared to radiofrequency. The costs associated with management of patients with hepatocellular carcinoma, treated with laser thermal ablation were lower than those treated with radiofrequency ablation.
References
Forner A, Llovet JM, Bruix J. Hepatocellular carcinoma. Lancet 2012; 379: 1245-55; https://doi.org/10.1016/S0140-6736(11)61347-0
European Association For The Study Of The Liver; European Organisation For Research And Treatment Of Cancer. EASL-EORTC clinical practice guidelines: management of hepatocellular carcinoma. J Hepatol 2012; 56: 908-43; https://doi.org/10.1016/j.jhep.2011.12.001
Facciorusso A, Serviddio G, Muscatiello N. Local ablative treatments for hepatocellular carcinoma: An updated review. World J Gastrointest Pharmacol Ther 2016; 7: 477-9; https://doi.org/10.4292/wjgpt.v7.i4.477
Orlacchio A, Bolacchi F, Chegai F, et al. Comparative evaluation of percutaneous laser and radiofrequency ablation in patients with HCC smaller than 4 cm. Radiol Med 2014; 119: 298-308; https://doi.org/10.1007/s11547-013-0339-y
Llovet JM, Mas X, Aponte JJ, et al. Cost effectiveness of adjuvant therapy for hepatocellular carcinoma during the waiting list for liver transplantation. Gut 2002;50: 123-8
Kudo M. Radiofrequency ablation for hepatocellular carcinoma: updated review in 2010. Oncology 2010; 78 Suppl 1: 113-24; https://doi.org/10.1159/000315239
Tatli S, Tapan U, Morrison PR, et al. Radiofrequency ablation: technique and clinical applications. Diagn Interv Radiol 2012; 18: 508-16; https://doi.org/10.4261/1305-3825.DIR.5168-11.1
Jacobs A. Radiofrequency Ablation for Liver Cancer. Radiol Technol 2015; 86: 645-64
Pacella CM, Francica G, Di Lascio FM, et al. Long-term outcome of cirrhotic patients with early hepatocellular carcinoma treated with ultrasound-guided percutaneous laser ablation: a retrospective analysis. J Clin Oncol 2009; 27: 2615-21; https://doi.org/10.1200/JCO.2008.19.0082
Pompili M, Pacella CM, Francica G, et al. Percutaneous laser ablation of hepatocellular carcinoma in patients with liver cirrhosis awaiting liver transplantation. Eur J Radiol 2010; 74: e6-e11; https://doi.org/10.1016/j.ejrad.2009.03.012
Di Costanzo GG, D’Adamo G, Tortora R, et al. A novel needle guide system to perform percutaneous laser ablation of liver tumors using the multifiber technique. Acta Radiol 2013; 54: 876-81; https://doi.org/10.1177/0284185113489825
Di Costanzo GG, Francica G, Pacella CM. Laser ablation for small hepatocellular carcinoma: State of the art and future perspectives. World J Hepatol 2014; 6: 704-15; https://doi.org/10.4254/wjh.v6.i10.704
Di Costanzo GG, Tortora R, D’Adamo G, et al. Radiofrequency ablation versus laser ablation for the treatment of small hepatocellular carcinoma in cirrhosis: a randomized trial. J Gastroenterol Hepatol 2015; 30: 559-65; https://doi.org/10.1111/jgh.12791
Nikfarjam M, Muralidharan V, Malcontenti-Wilson C, et al. Progressive microvascular injury in liver and colorectal liver metastases following laser induced focal hyperthermia therapy. Lasers Surg Med 2005; 37: 64-73; https://doi.org/10.1002/lsm.20194
Llovet JM, Bru C, Bruix J. Prognosis of hepatocellular carcinoma: the BCLC staging classification. Semin Liver Dis 1999; 19: 329-38; https://doi.org/10.1055/s-2007-1007122
Forner A, Reig ME, de Lope CR, et al. Current strategy for staging and treatment: the BCLC update and future prospects. Semin Liver Dis 2010; 30: 61-74; https://doi.org/10.1055/s-0030-1247133
Italian Association for the Study of the Liver (AISF); AISF Expert Panel; AISF Coordinating Committee, Bolondi L, Cillo U, Colombo M, et al. Position paper of the Italian Association for the Study of the Liver (AISF): the multidisciplinary clinical approach to hepatocellular carcinoma. Dig Liver Dis 2013; 45: 712-23; https://doi.org/10.1016/j.dld.2013.01.012
Lencioni R, Llovet JM. Modified RECIST (mRECIST) assessment for hepatocellular carcinoma. Semin Liver Dis 2010; 30: 52-60; https://doi.org/10.1055/s-0030-1247132
Goldberg SN, Grassi CJ, Cardella JF, et al.; Society of Interventional Radiology Technology Assessment Committee and the International Working Group on Image-guided Tumor Ablation. Image-guided tumor ablation: standardization of terminology and reporting criteria. J Vasc Interv Radiol 2009; 20(7Suppl): S377-90; https://doi.org/10.1016/j.jvir.2009.04.011
Agenzia Italiana del Farmaco Available at http://www.agenziafarmaco.gov.it/ (last accessed: March 2015)
Ministero della Salute. Remunerazione prestazioni di assistenza ospedaliera per acuti, assistenza ospedaliera di riabilitazione e di lungodegenza post acuzie e di assistenza specialistica ambulatoriale. G.U. n. 23 del 28 Gennaio 2013
Ferrari FS, Megliola A, Scorzelli A, et al. Treatment of small HCC through radiofrequency ablation and laser ablation. Comparison of techniques and long-term results. Radiol Med 2007; 112: 377-93; https://doi.org/10.1007/s11547-007-0148-2
Tapper EB, Catana AM, Sethi N, et al. Direct costs of care for hepatocellular carcinoma in patients with hepatitis C cirrhosis. Cancer 2016; 122: 852-8; https://doi.org/10.1002/cncr.29855
Copyright (c) 2019 Maria Guarino, Lucia Sara D'Angiolella, Luigia Falco, Federica Morando, Giuseppe Di Costanzo, Filomena Morisco, Giovanni Improta, Lorenzo Giovanni Mantovani, Nicola Caporaso

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