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

Abstract

IntroductionFor 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.MethodsWe 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).ResultsFour 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.ConclusionIn 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.