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Liver resection more cost-effective vs. transplantation for patients with HCC

In patients with hepatocellular carcinoma in the United States, Switzerland or Singapore, liver resection was more cost-effective than cadaveric liver transplantation, according to study data.

“Due to the large financial outlay and recurrent costs needed to run a liver transplant program for a large number of HCC patients, the decision to adopt either therapy as a first-time option carries major implications with respect to costs, utility of scarce resources and expectations of the population for quality health care,” the researchers wrote. “It is in this setting that a decision analytical model can help compare the two treatments from the perspective of the health care system.”

Researchers developed a Markov cohort model of patients aged 55 years with early HCC, defined by Milan criteria, and Child-Pugh A or B cirrhosis who underwent liver resection or cadaveric liver transplantation. A 1-month cycle time was used in the model to determine costs and quality of life impact among the patients. For analyses purposes, a cost-effective threshold of $50,000 per quality-adjusted life-years (QALY) was used for the US cost scenario, $51,507 per QALY for Switzerland and $50,123 per QALY for Singapore.

One-year survival rates were 94% in the liver resection group vs. 89% in the cadaveric liver transplant group; 74% vs. 69% for 3-year survival; and 53% vs. 57% at 5-year overall survival. After quality of life adjustments, liver resection produced 3.9 QALYs compared with 1.4 QALYS from cadaveric liver transplant.

The incremental cost-effectiveness ratios (ICERs) of cadaveric liver transplant compared with liver resection ranged from $111,821 per QALY in Singapore to $156,300 per QALY in Switzerland, according to the study results. All ICERs were above each country thresholds in all three countries, determining that cadaveric liver transplant was not a consistent cost-effective option compared with liver resection.

The median ICER in the United States was $110,712 per QALY, $151,599 per QALY for Switzerland and $108,889 per QALY in Singapore. ICERs decreased below threshold when 5-year overall survival related to cadaveric liver transplant was more than 84.9% in Singapore and 87.6% in the United States; Switzerland cost-effectiveness threshold was not affected.

“Our results indicated that although [cadaveric liver transplantation] offered improved life expectancy, it was not cost-effective compared to [liver resection] across all three countries at the base case,” the researchers concluded.

Disclosure: The researchers report no relevant financial disclosures.