Radiofrequency ablation plus nucleotide analogous for hepatitis B virus-related hepatocellular carcinoma: a cost-effectiveness analysis

In the real-world, it is unclear that after the radiofrequency ablation (RFA), whether it is a cost-effective strategy to administer nucleotide analogue (NA) for patients with hepatitis B virus (HBV)-related HCC patients. The aim of this study was to estimate the cost-effectiveness of the RFA plus NA versus RFA alone in patients with HBV-related HCC within the Milan criteria in China and the USA. A Markov model was developed to simulate a cohort of patients with HCC within the Milan criteria and Child-Pugh A/B cirrhosis and underwent RFA with or without NA therapy over their remaining life expectancy. Analysis was performed in two geographical cost settings: China and the USA. The RFA plus NA therapy provided an average of 7.57 years, whereas RFA monotherapy offered 5.83 years. The RFA plus NA therapy produced 5.09 quality-adjusted life years (QALYs), whereas RFA monotherapy achieved 3.89 QALYs. The incremental cost-effectiveness ratio (ICER) of the RFA plus NA therapy versus RFA monotherapy was $10368.19/QALY in China and $38805.45/QALY in the USA. These values were below the thresholds of the cost-effectiveness in both countries. Sensitivity analysis revealed that the utility of recurrent HCC was the most sensitive parameter in all cost scenarios in both of the RFA plus NA therapy and RFA monotherapy groups. Our Markov model has shown that for the patients with HBV-related HCC within the Milan criteria and Child-Pugh A/B cirrhosis, RFA plus NA is more cost-effective than RFA monotherapy across the two different cost scenarios namely, China and the USA.