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Updated: May 28, 2026
Application of the En Bloc Concept Combined with Anatomic Resection in Laparoscopic Hepatectomy
Published on: March 10, 2023
Cost-Effectiveness Analysis of Resection, Ablation and Radiation Segmentectomy for Solitary Hepatocellular Carcinoma
Xiao Wu1, Parmede Vakil2, Ammar Sarwar3
1Department of Radiology and Biomedical Imaging, University of California San Francisco, San Francisco, California.
Purpose:
To perform a cost-effectiveness analysis comparing liver resection, percutaneous thermal ablation (TA), and radiation segmentectomy (RS) for solitary hepatocellular carcinoma (HCC) ≤3 cm with curative intent.
Methods:
A cost-effectiveness analysis was performed comparing resection, TA, and RS for patients with solitary HCC ≤3 cm using a time horizon from a U.S. payor's perspective over 5 years using Markov modeling. Clinical outcomes were pooled from 4 comparative studies between ablation and resection. The outcomes after RS were pooled using 3 published studies and institutional data. Base case calculation and probabilistic and deterministic sensitivity analyses were performed.
Results:
Base case calculation showed TA to be the most cost-effective strategy. RS had the highest effectiveness (RS, 3.31 quality-adjusted life years [QALY]; 95% CI, 3.305-3.315; resection, 3.29 QALY; 95% CI, 3.286-3.294), and TA had the lower effectiveness of 3.20 QALY (95% CI, 3.196-3.204). Probabilistic sensitivity analysis showed ablation to be the most cost-effective strategy in 68.7% of iterations; resection, 20.6%; and RS, 10.8%. TA was the most cost-effective if its quarterly distant recurrence risk was lower than 2.8% (base case, 2.5%). Sensitivity analyses varying procedural costs showed resection to be cost-effective when its cost was below $26,779 or RS to be cost-effective when its cost was lower than $11,857.
Conclusions:
Ablation was the most cost-effective treatment of curative intent for patients with solitary HCC ≤3 cm, with RS having the highest effectiveness but overall higher cost driven by large proportion of surviving patients requiring routine follow-up care.
