Ethanol versus radiofrequency ablation for the treatment of small hepatocellular carcinoma in patients with cirrhosis -: A retrospective study of efficacy and cost

Objective - To compare cost effectiveness of radio-frequency (RF) ablation versus percutaneous ethanol (Pe) ablation for treatment of small hepatocellular carcinoma. Methods - 57 patients with 72 hepatocellular carcinomas (HCC) treated with ethanol ablation were retrospectively compared with 60 new patients who had 72 HCC treated with RF ablation. All patients had Child-Pugh A cirrhosis and HCC less than 3.5 cm in diameter. Therapeutic efficacy was evaluated with tri-phase spiral computed tomography. Cost of hospital stay, supplies and follow-up including complications were calculated. Survival was estimated by Kaplan-Meier method and prognostic value of treatment methods by Log Rank test and multivariate Cox proportional hazard model. Results - The two groups had similar baseline characteristics. The rate of severe complications associated with RF was 15% (9/60) vs 6,9% (9/60) with Pe (P = 0,11) The two-year overall survival, disease free survival and local tumor free survival in the ethanol and radiofrequency groups were 70.8% vs. 91.2% (Odd Ratio = 3.7, P = 0.006), 48.6% vs. 71.1% (Odd Ratio = 2.2, P = 0.01), and 68.5% vs. 80.7%, (Odd Ratio = 1.9; P = 0.09), respectively. The treatment method was the sole significant factor related to overall and tumor free survival. Costs per patient of ethanol and radiofrequency treatments were 1534 EURO and 1196 EURO, respectively. Conclusion - This retrospective study suggests that RF is the most cost effective strategy, with higher 2-year disesase free survival rate.