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. 2002 Jan;50(1):123-8.
doi: 10.1136/gut.50.1.123.

Cost effectiveness of adjuvant therapy for hepatocellular carcinoma during the waiting list for liver transplantation

J M Llovet  1 , X Mas, J J Aponte, J Fuster, M Navasa, E Christensen, J Rodés, J Bruix
Affiliations

Cost effectiveness of adjuvant therapy for hepatocellular carcinoma during the waiting list for liver transplantation

J M Llovet et al. Gut. 2002 Jan.

Abstract

Background: Survival after liver transplantation for early hepatocellular carcinoma (HCC) is worsened by the increasing dropout rate while waiting for a donor.

Aims: To assess the cost effectiveness of adjuvant therapy while waiting for liver transplantation in HCC patients.

Method: Using a Markov model, a hypothetical cohort of cirrhotic patients with early HCC was considered for: (1) adjuvant treatment-resection was limited to Child-Pugh's A patients with single tumours, and percutaneous treatment was considered for Child-Pugh's A and B patients with single tumours unsuitable for resection or with up to three nodules < 3 cm; and (2) standard management. Length of waiting time ranged from six to 24 months.

Results: Surgical resection increased the transplantation rate (>10%) and provided gains in life expectancy of 4.8-6.1 months with an acceptable cost ($40,000/ year of life gained) for waiting lists > or = 1 year whereas it was not cost effective ($74,000/life of year gained) for shorter waiting times or high dropout rate scenarios. Percutaneous treatment increased life expectancy by 5.2-6.7 months with a marginal cost of approximately $20,000/year of life gained in all cases, remaining cost effective for all waiting times.

Conclusions: Adjuvant therapies for HCC while waiting for liver transplantation provide moderate gains in life expectancy and are cost effective for waiting lists of one year or more. For shorter waiting times, only percutaneous treatment confers a relevant survival advantage.

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Figures

Figure 1
Figure 1
Diagram of the event pathway: decision tree and states of health.
Figure 2
Figure 2
Probability of being transplanted (A) and seven year intention to treat survival (B) comparing patients with hepatocellular carcinoma undergoing resection versus conservative management while on the waiting list for liver transplantation.
Figure 3
Figure 3
Probability of being transplanted (A) and seven year intention to treat survival (B) comparing patients with hepatocellular carcinoma undergoing percutaneous treatment versus conservative management while on the waiting list for liver transplantation.
Figure 4
Figure 4
Cost effectiveness analysis of surgical resection for hepatocellular carcinoma versus conservative management while on the waiting list for liver transplantation. Cost effectiveness ratio and marginal effectiveness in terms of gains in life expectancy are shown according to length of waiting time.
Figure 5
Figure 5
Cost effectiveness analysis of percutaneous treatments for non-surgical hepatocellular carcinoma versus conservative management while on the waiting list for liver transplantation. Cost effectiveness ratio and marginal effectiveness in terms of gains in life expectancy are shown according to length of waiting time.
See this image and copyright information in PMC

References

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    1. Llovet JM, Fuster J, Bruix J. Intention-to-treat analysis of surgical treatment for early hepatocellular carcinoma: resection versus transplantation. Hepatology 1999;30:1434–40. - PubMed
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