Cost effectiveness of adjuvant therapy for hepatocellular carcinoma during the waiting list for liver transplantation
J M Llovet1, X Mas, J J Aponte
1Barcelona-Clínic Liver Cancer Group, Liver Unit, Institut d'Investigacions Biomédiques August Pi I Sunyer (IDIBAPS), Hospital Clínic, University of Barcelona, Catalonia, Spain. jmllovet@clinic.ub.es
Gut
|January 5, 2002
Summary
Adjuvant therapies like percutaneous treatment improve survival for hepatocellular carcinoma (HCC) patients awaiting liver transplants. These treatments are cost-effective, especially for longer waiting times, offering significant life expectancy gains.
Area of Science:
- Hepatobiliary Surgery
- Transplant Oncology
- Health Economics
Background:
- Hepatocellular carcinoma (HCC) survival is compromised by donor waitlist dropout rates.
- Liver transplantation is a definitive treatment for early HCC.
- Adjuvant therapies are being explored to improve outcomes during the waitlist period.
Purpose of the Study:
- To evaluate the cost-effectiveness of adjuvant therapies for HCC patients awaiting liver transplantation.
- To compare surgical resection and percutaneous treatment strategies.
- To analyze outcomes based on varying waitlist durations.
Main Methods:
- A Markov model simulated a cohort of cirrhotic patients with early HCC.
- Adjuvant treatments included surgical resection and percutaneous interventions.
- Standard management served as the comparator, with wait times from 6 to 24 months.
Main Results:
- Surgical resection improved transplant rates and offered 4.8-6.1 months of life expectancy gain, cost-effective for waitlists >= 1 year.
- Percutaneous treatment yielded 5.2-6.7 months of life expectancy gain at ~$20,000/year gained, cost-effective across all wait times.
- Resection was not cost-effective for shorter waits or high dropout scenarios.
Conclusions:
- Adjuvant therapies for HCC patients awaiting liver transplantation offer moderate life expectancy benefits.
- Cost-effectiveness is demonstrated for waitlists of one year or more.
- Percutaneous treatment provides a survival advantage for shorter waiting periods.
