Impact of Extended Use of Ablation Techniques in Cirrhotic Patients with Hepatocellular Carcinoma: A Cost-Effectiveness Analysis
Abstract
:Simple Summary
Abstract
1. Introduction
2. Results
2.1. Study Population
2.2. Allocation of First-Line Treatments
2.3. Therapeutic Trajectories after First-Line Treatments
2.4. Overall Survival Analysis
2.5. Cost Effectiveness Analysis
3. Discussion
4. Materials and Methods
4.1. Patient Selection
4.2. Outcome
4.3. Model Structure
4.4. Health Costs
4.5. Cost-Effectiveness Analysis
4.6. Statistical Analysis
5. Conclusions
Supplementary Materials
Author Contributions
Funding
Institutional Review Board Statement
Informed Consent Statement
Data Availability Statement
Conflicts of Interest
References
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Baseline Characteristics | Unmatched Cohort | Matched Cohort | ||||
---|---|---|---|---|---|---|
Bondy Group | SOC Group | p-Value | Bondy Group | SOC Group | p-Value | |
n = 272 | n = 557 | n = 266 | n = 266 | |||
Age, mean (+/−SD) | 66 (+/−11) | 63 (+/−10) | <0.001 | 66 (+/−11) | 66 (+/−10) | 0.37 |
Male, n (%) | 219 (81%) | 464 (83%) | 0.32 | 214 (80%) | 211 (79%) | 0.75 |
Co-morbidity index, n (%) | 0.33 | 0.09 | ||||
≤1 | 262 (96%) | 528 (95%) | 256 (96%) | 247 (93%) | ||
>1 | 10 (4%) | 29 (5%) | 10 (4%) | 19 (7%) | ||
Cause of cirrhosis, n (%) | 0.02 | 0.87 | ||||
Alcohol | 118 (43%) | 190 (34%) | 113 (42%) | 117 (44%) | ||
HCV | 89 (33%) | 227 (41%) | 89 (33%) | 88 (33%) | ||
HBV | 34 (13%) | 83 (15%) | 34 (13%) | 32 (12%) | ||
NASH | 20 (7%) | 40 (7%) | 20 (8%) | 22 (8%) | ||
Others | 11 (4%) | 18 (3%) | 12 (5%) | 8 (3%) | ||
Child-Pugh score, n (%) | 0.14 | 0.88 | ||||
A (5–6) | 249 (92%) | 491 (88%) | 243 (91%) | 244 (92%) | ||
B (7–9) | 23 (8%) | 66 (12%) | 23 (9%) | 22 (8%) | ||
AFP level, n (%) | 0.70 | 0.45 | ||||
≤100 ng/mL | 191 (70%) | 398 (71%) | 189 (71%) | 178 (67%) | ||
100–1000 ng/mL | 50 (18%) | 97 (17%) | 48 (18%) | 50 (19%) | ||
>1000 ng/mL | 31 (11%) | 62 (11%) | 29 (11%) | 38 (14%) | ||
Portal hypertension, n (%) | 158 (58%) | 297 (53%) | 0.20 | 154 (58%) | 146 (55%) | 0.48 |
Size of the largest tumor node, n (%) | 0.42 | 0.29 | ||||
≤30 mm | 116 (43%) | 260 (47%) | 115 (43%) | 119 (45%) | ||
30–60 mm | 91 (33%) | 181 (32%) | 90 (34%) | 93 (35%) | ||
>60 mm | 65 (24%) | 116 (21%) | 61 (23%) | 54 (20%) | ||
Number of tumors, n (%) | 0.12 | 0.57 | ||||
1 | 170 (63%) | 314 (56%) | 165 (62%) | 166 (62%) | ||
2/3 | 63 (23%) | 167 (30%) | 63 (24%) | 61 (23%) | ||
≥4 | 39 (14%) | 76 (14%) | 38 (14%) | 39 (15%) | ||
Bilobar involvment, n (%) | 65 (24%) | 146 (26%) | 0.47 | 64 (24%) | 64 (24%) | 1 |
Vascular invasion, n (%) | 42 (15%) | 63 (11%) | 0.09 | 38 (14%) | 43 (16%) | 0.55 |
BCLC staging, n (%) | 0.01 | 0.57 | ||||
Very early | 16 (6%) | 60 (11%) | 16 (6%) | 22 (8%) | ||
Early | 159 (58%) | 290 (52%) | 157 (59%) | 143 (54%) | ||
Intermediate | 55 (20%) | 144 (26%) | 55 (21%) | 58 (22%) | ||
Advanced | 42 (15%) | 63 (11%) | 38 (14%) | 43 (16%) | ||
First-line treatment, n (%) | <0.001 | <0.001 | ||||
Hepatic resection | 1 (1%) | 69 (12%) | 1 (<1%) | 35 (13%) | ||
Ablation | 190 (70%) | 144 (26%) | 188 (71%) | 64 (24%) | ||
TACE | 48 (18%) | 283 (51%) | 47 (18%) | 128 (48%) | ||
TARE or Sorafenib | 32 (12%) | 60 (11%) | 30 (11%) | 39 (15%) |
Probability of First-Line Treatment | Bondy Group | SOC Group | |||
Hepatic resection | 0.4% | 13.2% | |||
Ablation | 70.7% | 24.0% | |||
TACE | 17.7% | 48.1% | |||
Sorafenib | 11.2% | 14.7% | |||
First-Line | Costs and Life-Years Per Patient | Bondy Group | SOC Group | Net Effects | ICER (€/LYG) |
Hepatic resection | Cost | €127 ($140) | €4417 ($4860) | €−4290 ($−4720) | |
Life-years | 0.1 | 2.6 | −2.5 | ||
Ablation | Cost | €14,488 ($15,937) | €4904 ($5394) | €9584 ($10,543) | |
Life-years | 11.1 | 3.8 | 7.3 | ||
TACE | Cost | €2268 ($2495) | €13,478 ($14,826) | €−11,210 ($−12,331) | |
Life-years | 0.7 | 4.3 | −3.6 | ||
Sorafenib | Cost | €1322 ($1454) | €2694 ($2963) | €−1372 ($−1509) | |
Life-years | 0.2 | 0.5 | −0.3 | ||
Average total | Cost | €18,205 ($20,026) | €25,493 ($28,043) | €−7288 ($−8017) | Dominant |
Life-years | 12 | 11.2 | 0.8 |
Parameters | Distribution | Mode | Minimum | Maximum |
---|---|---|---|---|
Health state cost | Gamma | |||
Hepatic resection | €17,666 ($19,432) | €16,900 ($18,590) | €18,300 ($20,130) | |
Ablation | €4895 ($5385) | €4400 ($4840) | €5000 ($5500) | |
TACE | €5708 ($6279) | €5500 ($6050) | €5800 ($6380) | |
Sorafenib | €4500 ($4950) | €2935 ($3229) | €10,320 ($11,352) | |
Liver transplantation | €51,779 ($56,957) | €48,900 ($53,790) | €54,000 ($59,400) | |
Follow-up after hepatic resection or ablation | €146 ($161) | €100 ($110) | €500 ($550) | |
Follow-up after TACE | €379 ($417) | €100 ($110) | €800 ($880) | |
Follow-up after liver transplantation | €1514 ($1665) | €594 ($653) | €2000 ($2200) | |
Start age | Triangular | 65 | 60 | 67 |
Transition probabilities | Beta | Original value | 10% lower | 10% higher |
Discount rate | Triangular | 3% | 0% | 6% |
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Ramtohul, T.; Vilgrain, V.; Soubrane, O.; Bouattour, M.; Luciani, A.; Kobeiter, H.; Mule, S.; Tacher, V.; Laurent, A.; Amaddeo, G.; et al. Impact of Extended Use of Ablation Techniques in Cirrhotic Patients with Hepatocellular Carcinoma: A Cost-Effectiveness Analysis. Cancers 2022, 14, 2634. https://doi.org/10.3390/cancers14112634
Ramtohul T, Vilgrain V, Soubrane O, Bouattour M, Luciani A, Kobeiter H, Mule S, Tacher V, Laurent A, Amaddeo G, et al. Impact of Extended Use of Ablation Techniques in Cirrhotic Patients with Hepatocellular Carcinoma: A Cost-Effectiveness Analysis. Cancers. 2022; 14(11):2634. https://doi.org/10.3390/cancers14112634
Chicago/Turabian StyleRamtohul, Toulsie, Valérie Vilgrain, Olivier Soubrane, Mohamed Bouattour, Alain Luciani, Hicham Kobeiter, Sébastien Mule, Vania Tacher, Alexis Laurent, Giuliana Amaddeo, and et al. 2022. "Impact of Extended Use of Ablation Techniques in Cirrhotic Patients with Hepatocellular Carcinoma: A Cost-Effectiveness Analysis" Cancers 14, no. 11: 2634. https://doi.org/10.3390/cancers14112634