Cost of radiofrequency ablation in the treatment of hepatic malignancies

Clinical outcomes and cost of open, laparoscopic, and percutaneous ablation for hepatocellular carcinoma

BACKGROUND

Open (OA), laparoscopic (LA), and percutaneous (PA) ablation are all ablation approaches for hepatocellular carcinoma (HCC) utilized in the United States today. However, it remains unclear today which approach is (A) most effective, (B) cost-efficient, and (C) nationally practiced.

METHODS

In-hospital mortality and cost were collected from the National Inpatient Sample (NIS) database for patients undergoing liver ablation from 2011 to 2018. Secondary outcomes included length of stay, disposition, and perioperative composite complications. We used inverse probability of treatment weighting (IPTW) to adjust for differences in patient and hospital baseline characteristics.

RESULTS

One thousand and one hundred and twenty-five LA, 1221 OA, and 1068 PA liver ablations were analyzed. After IPTW, in-hospital mortality risk was significantly lower in PA versus OA cohorts (0.57% vs. 2.90%, p < 0.001) and reduced among PA patients, yet not significantly different from the LA cohort (0.57% vs. 1.64%, p = 0.056). The median length of hospital stay was significantly lower in the PA and LA group compared to OA (2 days vs. 6 days, p < 0.001). The median hospitalization costs were significantly lower for PA ($44,884 vs. $90,187, p < 0.001) and LA ($61,445 vs. $90,187, p < 0.001) compared to OA. Moreover, we found significant regional differences regarding the use of each ablation approach, with the Midwest having the lowest rates of PA and LA.

CONCLUSIONS

Among patients hospitalized after ablation for HCC, PA leads to the lowest hospital cost. Both PA and LA result in lower peri-operative morbidity and mortality relative to OA. Despite these reported advantages, there are significant regional differences with respect to ablation availability suggesting the need to promote the standardization of best practices.

Locoregional Thermal and Chemical Tumor Ablation: Review of Clinical Applications and Potential Opportunities for Use in Low- and Middle-Income Countries

This review highlights opportunities to develop accessible ablative therapies to reduce the cancer burden in LMICs.

Cost Analysis of Radiofrequency Ablation for Adrenal Adenoma in Patients with Primary Aldosteronism and Hypertension: Results from the ADERADHTA Pilot Study and Comparison with Surgical Adrenalectomy

PURPOSE

Primary Aldosteronism (PA) is increasingly considered as a common disease affecting up to 10% of the hypertensive population. Standard of care comprises laparoscopic total adrenalectomy but innovative treatment such as RadioFrequency Ablation (RFA) constitutes an emerging promising alternative to surgery. The main aim of this study is to analyse the cost of RFA versus surgery on aldosterone-producing adenoma patient from the French National Health Insurance (FNHI) perspective.

METHODS

The ADERADHTA study was a prospective pilot study aiming to evaluate both safety and efficacy of the novel use of adrenal RFA on the patients with PA. This study conducted on two French sites and enrolled adult patients, between 2016 and 2018, presenting hypertension and underwent the RFA procedure. Direct medical (inpatient and outpatient) and non-medical (transportation, daily allowance) costs were calculated over a 6-month follow-up period. Moreover, the procedure costs for the RFA were calculated from the hospital perspective. Descriptive statistics were implemented.

RESULTS

Analysis was done on 21 patients in RFA groups and 27 patients in the surgery group. The difference in hospital costs between the RFA and surgery groups was €3774 (RFA: €1923; Surgery: €5697 p < 0.001) in favour of RFA. Inpatient and outpatient costs over the 6-month follow-up period were estimated at €3,48 for patients who underwent RFA. The production cost of implementing the RFA procedure was estimated at €1539 from the hospital perspective.

CONCLUSION

Our study was the first to show that RFA is 2 to 3 times less costly than surgery. The trial is registered at ClinicalTrials.gov under the number NCT02756754.

Percutaneous cryoablation of breast tumours in patients with stable metastatic breast cancer: safety, feasibility and efficacy

PURPOSE

To evaluate safety, feasibility and efficacy of percutaneous cryoablation of breast tumours in patients with clinically stable metastatic breast cancer, and to compare the findings with reports on alternative procedures, namely surgery and local radiotherapy.

METHODS

17 female patients (average age of 54.8 years ± 10.8; range 37-72) with primary breast tumour not surgically treated because of metastatic disease were included. Patients were treated for their primary lesion by percutaneous cryotherapy in period of stable disease. This minimally intervention was performed using ultrasound or CT scan guidance. All patients had clinical and breast-MRI evaluation before and at 1, 3, 6 and 12 months after the procedure.

RESULTS

All procedures were performed under local anaesthesia and technically successful. The mean largest diameter of the primary lesions was 16 ± 12 mm (size range 5-45 mm). In 15 patients, we obtained a complete regression of the primary breast lesion without recurrence during the follow-up period. Two patients with lesions measured at 40 and 45 mm had recurrence in follow up period. A second session of cryotherapy was performed for these 2 patients, not included in this study. Five patients had painful masses before cryotherapy. All were immediately relieved after the intervention and durably during all follow-up.

CONCLUSION

These results show that the cryoablation of primary breast lesions seems to be well suited to the palliative care of metastatic patients, particularly because of its good tolerance, low complication rate and ability to provide local or analgesic control. Advances in knowledge: Therapies are limited for these symptomatic patients at metastatic state of primary breast tumour. This study shows that cryoablation in palliative care is achievable in common practice, is effective in local control of the tumour and can provide immediate and long-term analgesic control.

Cost-effectiveness of hepatic resection versus percutaneous radiofrequency ablation for early hepatocellular carcinoma

BACKGROUND & AIMS

Both hepatic resection and radiofrequency ablation (RFA) are considered curative treatments for hepatocellular carcinoma (HCC), but their economic impact still remains not determined. Aim of the present study was to analyze the cost-effectiveness (CE) of these two strategies in early stage HCC (Milan criteria).

METHODS

As first step, a meta-analysis of the pertinent literature of the last decade was performed. Seventeen studies fulfilled the inclusion criteria: 3996 patients underwent resection and 4424 underwent RFA for early HCC. Data obtained from the meta-analysis were used to construct a Markov model. Costs were assessed from the health care provider perspective. A Monte Carlo probabilistic sensitivity analysis was used to estimate outcomes with distribution samples of 1000 patients for each treatment arm.

RESULTS

In a 10-year perspective, for very early HCC (single nodule <2 cm) in Child-Pugh class A patients, RFA provided similar life-expectancy and quality-adjusted life-expectancy at a lower cost than resection and was the most cost-effective therapeutic strategy. For single HCCs of 3-5 cm, resection provided better life-expectancy and was more cost-effective than RFA, at a willingness-to-pay above €4200 per quality-adjusted life-year. In the presence of two or three nodules ≤3 cm, life-expectancy and quality-adjusted life-expectancy were very similar between the two treatments, but cost-effectiveness was again in favour of RFA.

CONCLUSIONS

For very early HCC and in the presence of two or three nodules ≤3 cm, RFA is more cost-effective than resection; for single larger early stage HCCs, surgical resection remains the best strategy to adopt as a result of better survival rates at an acceptable increase in cost.

Consumption of national health insurance medical resources by hepatocellular carcinoma patients treated using radiofrequency ablation therapy

AIM

This study analyzed the health-care resources consumed in cancer treatment to provide important reference guidance to national governments with regard to their health-care policy prioritization and efficient health-care resource allocation.

METHODS

Researchers used a retrospective observational approach to study medical resources consumed by hospitalized hepatocellular carcinoma (HCC) patients who underwent radiofrequency ablation (RFA) treatment in Taiwan between 2002 and 2006.

RESULTS

A systemic analysis of the results showed a mean patient age of 65.3 and average medical costs per patient of US$1403. Higher incidence of HCC was evident in rural areas in Taiwan, however smaller hospitals treated fewer patients diagnosed with HCC due to many patients seeking treatment at larger hospitals, usually in urban areas. Consumption of medical resources at regional hospitals was significantly higher than at medical centers in terms of costs of X-rays and special materials as well as for the overall cost of treatment (P < 0.001). The average medical costs for hospitalized cancer patients who underwent RFA treatment were lower than for those that received other treatments such as surgical resection, TACE, radiotherapy or chemotherapy. This study further found an upward trend in the number of HCC patients receiving RFA treatments.

CONCLUSION

Taiwan operates a national insurance global budget payment system. Health-care system budgetary pressures are exacerbated by increases in the costs of cancer treatment. While the cost of RFA for HCC may represent value for money, with cost savings in other treatment areas, it nonetheless places strain on Taiwan NHI global budget payment system.

[Process-oriented cost calculation in interventional radiology. A case study]

PURPOSE

Currently used costing methods such as cost centre accounting do not sufficiently reflect the process-based resource utilization in medicine. The goal of this study was to establish a process-oriented cost assessment of percutaneous radiofrequency (RF) ablation of liver and lung metastases.

MATERIAL AND METHODS

In each of 15 patients a detailed task analysis of the primary process of hepatic and pulmonary RF ablation was performed. Based on these data a dedicated cost calculation model was developed for each primary process. The costs of each process were computed and compared with the revenue for in-patients according to the German diagnosis-related groups (DRG) system 2010.

RESULTS

The RF ablation of liver metastases in patients without relevant comorbidities and a low patient complexity level results in a loss of EUR 588.44, whereas the treatment of patients with a higher complexity level yields an acceptable profit. The treatment of pulmonary metastases is profitable even in cases of additional expenses due to complications.

CONCLUSION

Process-oriented costing provides relevant information that is needed for understanding the economic impact of treatment decisions. It is well suited as a starting point for economically driven process optimization and reengineering. Under the terms of the German DRG 2010 system percutaneous RF ablation of lung metastases is economically reasonable, while RF ablation of liver metastases in cases of low patient complexity levels does not cover the costs.

Radiofrequency ablation of liver tumors: Actual limitations and potential solutions in the future

Over the past decade, radiofrequency ablation (RFA) has evolved into an important therapeutical tool for the treatment of non resectable primary and secondary liver tumors. The clinical benefit of RFA is represented in several clinical studies. They underline the safety and feasibility of this new and modern concept in treating liver tumors. RFA has proven its clinical impact not only in hepatocellular carcinoma (HCC) but also in metastatic disease such as colorectal cancer (CRC). Due to the increasing number of HCC and CRC, RFA might play an even more important role in the future. Therefore, the refinement of RFA technology is as important as the evaluation of data of prospective randomized trials that will help define guidelines for good clinical practice in RFA application in the future. The combination of hepatic resection and RFA extends the feasibility of open surgical procedures in patients with extensive tumors. Adverse effects of RFA such as biliary tract damage, liver failure and local recurrence remain an important task today but overall the long term results of RFA application in treating liver tumors are promising. Incomplete ablation of liver tumors due to insufficient technology of ablation needles, tissue cooling by the neighbouring blood vessels, large tumor masses and ablation of tumors in close vicinity to heat sensitive organs remain difficult tasks for RFA. Future solutions to overcome these limitations of RFA will include refinement of ultrasonographic guidance (accuracy of probe placement), improvements in needle technology (e.g. needles preventing charring) and intraductal cooling techniques.

Curative treatment of colorectal peritoneal carcinomatosis: current status and future trends

A new therapeutic approach to treat colorectal peritoneal carcinomatosis (PC) is becoming increasingly popular. Its main principle is to treat the macroscopic (visible) malignant peritoneal disease with complete cytoreductive surgery and, immediately after, to treat the remaining microscopic (non visible) malignant peritoneal disease with hyperthermic intraperitoneal chemotherapy (HIPEC). This combined treatment has become the gold standard approach when feasible. It is associated with good oncologic results, considering a 5-year survival rate close to 40% when complete cytoreductive surgery is achieved, and acceptable surgical results, considering a postoperative mortality rate ranging from 3 to 5% and a postoperative morbidity rate ranging from 30 to 50%. The exact effects of each steps of this combined treatment are currently unknown; therefore a randomized controlled trial is on going evaluating the real impact of HIPEC by itself (randomization with or without HIPEC after a complete cytoreductive surgery). One of the future indications of this combined approach might be its use in the very early development of PC. Indeed, early PC is currently only detectable and treatable during a second-look surgery, as recently demonstrated in high-risk patients. A trial is currently comparing the oncologic benefits of this second-look approach with HIPEC to the usual simple survey in patients with a high risk to develop PC.