Abstract 954P
Background
Whether hepatectomy (HT) or radiofrequency ablation (RFA) is a better treatment choice for hepatocellular carcinoma (HCC) is controversial. In addition, few reports have compared the medical costs of HT and RFA in clinical practice.
Methods
Patients who were diagnosed with HCC and underwent HT or RFA for initial treatment were selected from the Diagnosis Procedure Combination database from 393 Japanese institutions from 2012 to 2019. A 1:1 propensity score-matching analysis was performed to adjust for patient background in both groups, with the following factors: year of first treatment, sex, age at treatment, stage of cancer, Charlson Comorbidity Index (CCI), HBV, HCV, and cirrhosis. The index of medical cost was the per capita medical cost (K USD = 1,000 USD) for 3 years by Bang and Tsiatis' method. The primary outcome was survival rate at 3-year follow-up, and secondary outcome were progression free survival (PFS) rate.
Results
After PS matching, there were 749 patients in each group. The mean 3-year per capita medical cost (95% confidence interval) was 46.2 (42.3 - 51.7) K USD for HT and 39.9 (37.6 - 42.2) K USD for RFA, which was statistically significantly higher for HT. The breakdown of medical costs showed that surgical costs were the highest for HT at 13.1 K USD, and drug costs were the highest for RFA at 14.6 K USD. The breakdown of drug cost was highest for viral hepatitis products for both HT and RFA at 6.55 and 8.55 K USD respectively. The factors associated with high 3-year medical costs were year of treatment, HCV positivity, and age for HT, whereas year of treatment and CCI for RFA. 3-year survival rates were 89.6% and 85.3% (RFA vs HT：hazard ratio [95% confidence interval]: 1.31, 0.96 - 1.80), respectively, and the PFS rate was 62.2% and 49.9% at 3 years (1.50 [1.27 - 1.77]) respectively.
Conclusions
There was no statistical difference in patients’ outcome between hepatectomy and RFA for HCC, and the medical cost burden was significantly greater for hepatectomy. Providing patients with appropriate information based on the results of this study could help them make treatment choices.
Clinical trial identification
Editorial acknowledgement
Legal entity responsible for the study
Eisai Co., Ltd.
Funding
Eisai Co., Ltd.
Disclosure
T. Terashima: Financial Interests, Personal, Advisory Role: Eisai Co., Ltd. Y. Higashibeppu: Other, Personal, Employee of Eisai: Eisai Co., Ltd. T. Yamashita: Financial Interests, Personal, Advisory Role: Eisai Co., Ltd. Y. Sakata: Other, Personal, Employees of Eisai: Eisai Co., Ltd. M. Azuma: Other, Personal, Employee of Eisai: Eisai Co., Ltd. K. Fujimoto: Other, Personal, Employee of Eisai: Eisai Co., Ltd. H. Munakata: Other, Personal, Employee of Eisai: Eisai Co., Ltd. M. Ishii: Other, Personal, Employee of Eisai: Eisai Co., Ltd. S. Kaneko: Financial Interests, Personal, Advisory Role: Eisai Co., Ltd.