Effectiveness and cost of radiofrequency ablation and stereotactic body radiotherapy for treatment of early-stage hepatocellular carcinoma: An analysis of SEER-medicare

Neehar D. Parikh, Vincent D. Marshall, Michael Green, Theodore S. Lawrence, Nataliya Razumilava, Dawn Owen, Amit G. Singal, Mary Feng

Research output: Contribution to journalReview article

2 Citations (Scopus)

Abstract

Introduction: For early-stage hepatocellular carcinoma (HCC) patients, ablative strategies are potentially curative treatment options. Stereotactic body radiotherapy (SBRT) has emerged as a promising ablative therapy, although its comparison with radiofrequency ablation (RFA) remains confined to a single institution retrospective review. We sought to characterize the comparative outcomes and cost between the two treatment strategies. Methods: We conducted a secondary analysis of the Surveillance, Epidemiology, and End Results (SEER)-Medicare linked database (2004–2011) and identified adult patients with stage I or II HCC and treated with RFA or SBRT as the initial treatment within 6 months of diagnosis. Survival analysis was conducted using Kaplan–Meier curves and multivariate Cox proportional hazard analysis. Factors associated with overall survival and 90-day hospital admission post-treatment were identified using propensity score (PS) adjusted multivariate analysis. We performed costs analysis and calculated incremental cost-effectiveness ratios (ICER). Results: Four hundred and forty patients were identified, 408 treated with RFA and 32 SBRT. In the overall cohort, 90-day hospitalization and 1-year mortality were similar between groups but RFA patients had better overall survival (P < 0.001). Multivariate analysis showed advanced age, higher stage, decompensated cirrhosis, and treatment with SBRT (HR 1.80; 95%CI: 1.15–2.82) was associated with worse survival, but in the PS adjusted analysis, survival and costs were similar between the two groups. Conclusion: In a national cohort of early stage HCC patients, treatment with RFA vs SBRT resulted in no significant difference in survival, 90-day hospitalization, or costs. These data highlight the need for a randomized clinical trial comparing these two modalities.

Original languageEnglish (US)
Pages (from-to)673-681
Number of pages9
JournalJournal of Medical Imaging and Radiation Oncology
Volume62
Issue number5
DOIs
StatePublished - Oct 1 2018

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Radiosurgery
Medicare
Cost-Benefit Analysis
Hepatocellular Carcinoma
Epidemiology
Costs and Cost Analysis
Propensity Score
Survival
Survival Analysis
Therapeutics
Hospitalization
Multivariate Analysis
Fibrosis
Randomized Controlled Trials
Databases
Mortality

Keywords

  • comparative
  • HCC
  • ICER
  • RFA
  • SBRT

ASJC Scopus subject areas

  • Oncology
  • Radiology Nuclear Medicine and imaging

Cite this

Effectiveness and cost of radiofrequency ablation and stereotactic body radiotherapy for treatment of early-stage hepatocellular carcinoma : An analysis of SEER-medicare. / Parikh, Neehar D.; Marshall, Vincent D.; Green, Michael; Lawrence, Theodore S.; Razumilava, Nataliya; Owen, Dawn; Singal, Amit G.; Feng, Mary.

In: Journal of Medical Imaging and Radiation Oncology, Vol. 62, No. 5, 01.10.2018, p. 673-681.

Research output: Contribution to journalReview article

Parikh, Neehar D. ; Marshall, Vincent D. ; Green, Michael ; Lawrence, Theodore S. ; Razumilava, Nataliya ; Owen, Dawn ; Singal, Amit G. ; Feng, Mary. / Effectiveness and cost of radiofrequency ablation and stereotactic body radiotherapy for treatment of early-stage hepatocellular carcinoma : An analysis of SEER-medicare. In: Journal of Medical Imaging and Radiation Oncology. 2018 ; Vol. 62, No. 5. pp. 673-681.
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abstract = "Introduction: For early-stage hepatocellular carcinoma (HCC) patients, ablative strategies are potentially curative treatment options. Stereotactic body radiotherapy (SBRT) has emerged as a promising ablative therapy, although its comparison with radiofrequency ablation (RFA) remains confined to a single institution retrospective review. We sought to characterize the comparative outcomes and cost between the two treatment strategies. Methods: We conducted a secondary analysis of the Surveillance, Epidemiology, and End Results (SEER)-Medicare linked database (2004–2011) and identified adult patients with stage I or II HCC and treated with RFA or SBRT as the initial treatment within 6 months of diagnosis. Survival analysis was conducted using Kaplan–Meier curves and multivariate Cox proportional hazard analysis. Factors associated with overall survival and 90-day hospital admission post-treatment were identified using propensity score (PS) adjusted multivariate analysis. We performed costs analysis and calculated incremental cost-effectiveness ratios (ICER). Results: Four hundred and forty patients were identified, 408 treated with RFA and 32 SBRT. In the overall cohort, 90-day hospitalization and 1-year mortality were similar between groups but RFA patients had better overall survival (P < 0.001). Multivariate analysis showed advanced age, higher stage, decompensated cirrhosis, and treatment with SBRT (HR 1.80; 95{\%}CI: 1.15–2.82) was associated with worse survival, but in the PS adjusted analysis, survival and costs were similar between the two groups. Conclusion: In a national cohort of early stage HCC patients, treatment with RFA vs SBRT resulted in no significant difference in survival, 90-day hospitalization, or costs. These data highlight the need for a randomized clinical trial comparing these two modalities.",
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T1 - Effectiveness and cost of radiofrequency ablation and stereotactic body radiotherapy for treatment of early-stage hepatocellular carcinoma

T2 - An analysis of SEER-medicare

AU - Parikh, Neehar D.

AU - Marshall, Vincent D.

AU - Green, Michael

AU - Lawrence, Theodore S.

AU - Razumilava, Nataliya

AU - Owen, Dawn

AU - Singal, Amit G.

AU - Feng, Mary

PY - 2018/10/1

Y1 - 2018/10/1

N2 - Introduction: For early-stage hepatocellular carcinoma (HCC) patients, ablative strategies are potentially curative treatment options. Stereotactic body radiotherapy (SBRT) has emerged as a promising ablative therapy, although its comparison with radiofrequency ablation (RFA) remains confined to a single institution retrospective review. We sought to characterize the comparative outcomes and cost between the two treatment strategies. Methods: We conducted a secondary analysis of the Surveillance, Epidemiology, and End Results (SEER)-Medicare linked database (2004–2011) and identified adult patients with stage I or II HCC and treated with RFA or SBRT as the initial treatment within 6 months of diagnosis. Survival analysis was conducted using Kaplan–Meier curves and multivariate Cox proportional hazard analysis. Factors associated with overall survival and 90-day hospital admission post-treatment were identified using propensity score (PS) adjusted multivariate analysis. We performed costs analysis and calculated incremental cost-effectiveness ratios (ICER). Results: Four hundred and forty patients were identified, 408 treated with RFA and 32 SBRT. In the overall cohort, 90-day hospitalization and 1-year mortality were similar between groups but RFA patients had better overall survival (P < 0.001). Multivariate analysis showed advanced age, higher stage, decompensated cirrhosis, and treatment with SBRT (HR 1.80; 95%CI: 1.15–2.82) was associated with worse survival, but in the PS adjusted analysis, survival and costs were similar between the two groups. Conclusion: In a national cohort of early stage HCC patients, treatment with RFA vs SBRT resulted in no significant difference in survival, 90-day hospitalization, or costs. These data highlight the need for a randomized clinical trial comparing these two modalities.

AB - Introduction: For early-stage hepatocellular carcinoma (HCC) patients, ablative strategies are potentially curative treatment options. Stereotactic body radiotherapy (SBRT) has emerged as a promising ablative therapy, although its comparison with radiofrequency ablation (RFA) remains confined to a single institution retrospective review. We sought to characterize the comparative outcomes and cost between the two treatment strategies. Methods: We conducted a secondary analysis of the Surveillance, Epidemiology, and End Results (SEER)-Medicare linked database (2004–2011) and identified adult patients with stage I or II HCC and treated with RFA or SBRT as the initial treatment within 6 months of diagnosis. Survival analysis was conducted using Kaplan–Meier curves and multivariate Cox proportional hazard analysis. Factors associated with overall survival and 90-day hospital admission post-treatment were identified using propensity score (PS) adjusted multivariate analysis. We performed costs analysis and calculated incremental cost-effectiveness ratios (ICER). Results: Four hundred and forty patients were identified, 408 treated with RFA and 32 SBRT. In the overall cohort, 90-day hospitalization and 1-year mortality were similar between groups but RFA patients had better overall survival (P < 0.001). Multivariate analysis showed advanced age, higher stage, decompensated cirrhosis, and treatment with SBRT (HR 1.80; 95%CI: 1.15–2.82) was associated with worse survival, but in the PS adjusted analysis, survival and costs were similar between the two groups. Conclusion: In a national cohort of early stage HCC patients, treatment with RFA vs SBRT resulted in no significant difference in survival, 90-day hospitalization, or costs. These data highlight the need for a randomized clinical trial comparing these two modalities.

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