Cost-effectiveness of percutaneous radiofrequency ablation for malignant hepatic neoplasms

PURPOSE: Percutaneous radiofrequency (RF) ablation is a promising technique for the treatment of hepatic malignancies. However, its cost-effectiveness has not been established. The purpose of this study is to determine the co st-effectiveness of RF ablation compared to palliative care in the treatmen t of hepatocellular cancer and colorectal liver metastases. This study also seeks to evaluate the effects of transition from traditional to newly impl emented prospective outpatient reimbursement mechanisms on RF ablation cost -effectiveness, MATERIALS AND METHODS: The marginal direct costs of a percutaneous RF ablat ion treatment strategy were compared to palliative care over a range of sur vival benefits with use of a cost-effectiveness model built from the perspe ctive of the payer. Variables used in the model, including complication rat es and procedure efficacy, were obtained from the literature and the author s' experience with 46 consecutive patients. RESULTS: The cost-effectiveness of a standardized percutaneous RF ablation treatment strategy compared to palliative care was $20,424, $11,407, $5,034 , and $3,492, respectively, per life-year (LY) gained when marginal median survival conferred by RF ablation is 6 months, 1 year, 3 years, and 5 years . The RF ablation treatment strategy would be required to generate 6.14, 2. 26, and 1.10 months of marginal median survival benefit to achieve strict ( $20,000/LY gained), moderate ($50,000/LY gained), and generous ($100,000/LY gained) cost-effectiveness thresholds. Cost-effectiveness was sensitive to the number of lifetime treatments, hours of observation time, frequency of follow-up evaluations, cost of abdominal computed tomography, and decision to perform RF ablation as an inpatient or outpatient. CONCLUSION: Percutaneous RF ablation is a cost-effective treatment strategy compared to palliative care and has likely already achieved the survival b enefit required to meet even a strict cost-effectiveness criterion. Depende nce on reimbursement mechanism highlights the importance of concordance bet ween policy and RF ablation technology. The results of this study allow fle xible application of cost-effectiveness data despite current uncertainties in treatment and survival data and heterogeneity in treatment populations.