Cost‐effectiveness analysis of liver resection versus transplantation for early hepatocellular carcinoma within the Milan criteria

• DOI: 10.1002/hep.27135
• Publication Date: 2014-03-18T10:42:40Z
• Authors: Kheng Choon Lim; Vivian W. Wang; Fahad J. Siddiqui; Luming Shi; Edwin S.Y. Chan; Hong Choon Oh; Say Beng Tan; Pierce K.H. Chow
• Keywords: Milan criteria

Both liver resection (LR) and cadaveric transplantation (CLT) are potentially curative treatments for patients with hepatocellular carcinoma (HCC) within the Milan criteria adequate function. Adopting either as a first-line therapy carries major cost resource implications. The objective of this study was to estimate relative cost-effectiveness LR against CLT HCC using decision analytic model. A Markov cohort model developed simulate aged 55 years Child-Pugh A/B cirrhosis, undergoing or CLT, followed up over their remaining life expectancy. Analysis performed in different geographical settings: USA, Switzerland Singapore. Transition probabilities were obtained from systematic literature reviews, supplemented by databases Singapore Organ Procurement Transplantation Network (USA). Utility data open sources. produced 3.9 quality-adjusted (QALYs) while had an additional 1.4 QALYs. incremental ratio (ICER) versus ranged $111,821/QALY $156,300/QALY Switzerland, above thresholds all three countries. Sensitivity analysis revealed that CLT-related 5-year cumulative survival, one-time post-LR recurrence rates most sensitive parameters scenarios. ICERs reduced below threshold when survival exceeded 84.9% 87.6% respectively. For ICER remained regardless variations.In is more cost-effective than across costing scenarios: