PMID- 25665675
OWN - NLM
STAT- MEDLINE
DCOM- 20151130
LR  - 20181113
IS  - 1432-2323 (Electronic)
IS  - 0364-2313 (Linking)
VI  - 39
IP  - 6
DP  - 2015 Jun
TI  - The relative net health benefit of liver resection, ablation, and transplantation 
      for early hepatocellular carcinoma.
PG  - 1474-84
LID - 10.1007/s00268-015-2987-7 [doi]
AB  - BACKGROUND: There are no conclusive cost-effectiveness studies measuring the 
      efficacy of salvage LT after liver resection (LR) and radiofrequency ablation 
      (RFA) in patients with early hepatocellular carcinoma (HCC) and compensated 
      cirrhosis. The aim of the present study is to compare liver transplantation (LT) 
      versus locoregional therapy plus salvage LT (to treat tumor recurrence) in 
      patients with early HCC and compensated cirrhosis. METHODS: Reference case: 
      55-year old male with HCC within Milan criteria and Child-Pugh A cirrhosis. The 
      analysis was performed in two geographical cost settings: USA and Italy. Survival 
      benefit measured in quality-adjusted life years (QALYs), costs (C) in US$, 
      incremental cost-effectiveness, willingness to pay, and net health benefit (NHB). 
      RESULTS: In the base-case analysis, NHB of LT vs. LR and RFA was -1.7 and -1.3 
      years for single tumor </=3 cm, -1.2 and -0.7 for single nodules measuring 3.1-5 cm 
      and -0.7 and -0.7 for multi-nodular tumor </=3 cm in Italy. In USA, NHB of LT 
      versus LR and RFA were -1.2 and -0.8 years for single tumor </=3 cm, -0.9 and -0.5 
      for single nodules measuring 3.1-5 cm, and -0.5 and -0.4 for multi-nodular tumor 
      </= 3 cm. On the Monte Carlo simulation, only young patients with multi-nodular HCC 
      and short waiting list time had a positive NHB. Salvage LT proved to be an 
      ineffective cost strategy after RFA or LR. CONCLUSION: In patients with HCC 
      within Milan criteria and Child-Pugh A cirrhosis, LR and RFA were more 
      cost-effective than LT. Salvage LT was not cost-effective.
FAU - Spolverato, Gaya
AU  - Spolverato G
AD  - Department of Surgery, The Johns Hopkins University School of Medicine, 600 N. 
      Wolfe Street, Blalock 688, Baltimore, MD, 21287, USA.
FAU - Vitale, Alessandro
AU  - Vitale A
FAU - Ejaz, Aslam
AU  - Ejaz A
FAU - Kim, Yuhree
AU  - Kim Y
FAU - Maithel, Shishir K
AU  - Maithel SK
FAU - Cosgrove, David P
AU  - Cosgrove DP
FAU - Pawlik, Timothy M
AU  - Pawlik TM
LA  - eng
PT  - Comparative Study
PT  - Journal Article
PL  - United States
TA  - World J Surg
JT  - World journal of surgery
JID - 7704052
SB  - IM
MH  - Carcinoma, Hepatocellular/complications/pathology/*surgery
MH  - *Catheter Ablation/economics
MH  - Cost-Benefit Analysis
MH  - *Hepatectomy/economics
MH  - Humans
MH  - Italy
MH  - Liver Cirrhosis/complications/surgery
MH  - Liver Neoplasms/complications/pathology/*surgery
MH  - *Liver Transplantation/economics
MH  - Male
MH  - Middle Aged
MH  - Monte Carlo Method
MH  - Neoplasm Recurrence, Local/surgery
MH  - Quality-Adjusted Life Years
MH  - Salvage Therapy
MH  - United States
MH  - Waiting Lists
EDAT- 2015/02/11 06:00
MHDA- 2015/12/15 06:00
CRDT- 2015/02/11 06:00
PHST- 2015/02/11 06:00 [entrez]
PHST- 2015/02/11 06:00 [pubmed]
PHST- 2015/12/15 06:00 [medline]
AID - 10.1007/s00268-015-2987-7 [doi]
PST - ppublish
SO  - World J Surg. 2015 Jun;39(6):1474-84. doi: 10.1007/s00268-015-2987-7.