Cost-Effectiveness of Navigated Radiofrequency Ablation for Hepatocellular Carcinoma in China

Lai, Yizhen; Li, Kai; Li, Junbo; Liu, Sheena Xin

doi:10.1017/s0266462314000452

Cited by 3 publications

(6 citation statements)

References 28 publications

Supporting

Mentioning

Contrasting

Order By: Relevance

“…In practice, minimally invasive stereotactic ablation approaches are beneficial especially in these situations, where they allow a curative intended treatment when conventional image guidance techniques preclude an efficient and safe targeting. Key challenges remaining to be addressed when using current navigation technology are potential inaccuracies due to motion artifacts ( 73 ) and concerns regarding cost effectiveness ( 74 ).…”

Section: Discussionmentioning

confidence: 99%

Stereotactic and Robotic Minimally Invasive Thermal Ablation of Malignant Liver Tumors: A Systematic Review and Meta-Analysis

et al. 2021

View full text Add to dashboard Cite

BackgroundStereotactic navigation techniques aim to enhance treatment precision and safety in minimally invasive thermal ablation of liver tumors. We qualitatively reviewed and quantitatively summarized the available literature on procedural and clinical outcomes after stereotactic navigated ablation of malignant liver tumors.MethodsA systematic literature search was performed on procedural and clinical outcomes when using stereotactic or robotic navigation for laparoscopic or percutaneous thermal ablation. The online databases Medline, Embase, and Cochrane Library were searched. Endpoints included targeting accuracy, procedural efficiency, and treatment efficacy outcomes. Meta-analysis including subgroup analyses was performed.ResultsThirty-four studies (two randomized controlled trials, three prospective cohort studies, 29 case series) were qualitatively analyzed, and 22 studies were included for meta-analysis. Weighted average lateral targeting error was 3.7 mm (CI 3.2, 4.2), with all four comparative studies showing enhanced targeting accuracy compared to free-hand targeting. Weighted average overall complications, major complications, and mortality were 11.4% (6.7, 16.1), 3.4% (2.1, 5.1), and 0.8% (0.5, 1.3). Pooled estimates of primary technique efficacy were 94% (89, 97) if assessed at 1–6 weeks and 90% (87, 93) if assessed at 6–12 weeks post ablation, with remaining between-study heterogeneity. Primary technique efficacy was significantly enhanced in stereotactic vs. free-hand targeting, with odds ratio (OR) of 1.9 (1.2, 3.2) (n = 6 studies).ConclusionsAdvances in stereotactic navigation technologies allow highly precise and safe tumor targeting, leading to enhanced primary treatment efficacy. The use of varying definitions and terminology of safety and efficacy limits comparability among studies, highlighting the crucial need for further standardization of follow-up definitions.

show abstract

Section: Discussionmentioning

confidence: 99%

Stereotactic and Robotic Minimally Invasive Thermal Ablation of Malignant Liver Tumors: A Systematic Review and Meta-Analysis

et al. 2021

View full text Add to dashboard Cite

show abstract

“…In practice, minimally invasive stereotactic ablation approaches are bene cial especially in these situations, where they allow a curative intended treatment when conventional image guidance techniques preclude an e cient and safe targeting. Key challenges remaining to be addressed when using current navigation technology are potential inaccuracies due to motion artefacts (73) and concerns regarding cost effectiveness (74).…”

Section: Discussionmentioning

confidence: 99%

Stereotactic and Robotic Minimally Invasive Thermal Ablation of Malignant Liver Tumours - A Systematic Review and Meta-Analysis

Tinguely

Paolucci

Ruiter

et al. 2020

Preprint

View full text Add to dashboard Cite

Background: Stereotactic navigation techniques aim to enhance treatment precision and safety in minimally invasive thermal ablation of liver tumours. We qualitatively reviewed and quantitatively summarised the available literature on procedural and clinical outcomes after stereotactic navigated ablation of malignant liver tumours.Methods: A systematic literature search was performed on procedural and clinical outcomes when using stereotactic or robotic navigation for laparoscopic or percutaneous thermal ablation. The online databases Medline, Embase and Cochrane Library were searched. Endpoints included targeting accuracy, procedural efficiency and treatment efficacy outcomes. Meta-analysis including subgroup analyses were performed.Results: Thirty-four studies (2 randomised controlled trials, 3 prospective cohort studies, 29 case series) were qualitatively analysed and 22 studies included for meta-analysis. Weighted average lateral targeting error was 3.7mm (CI 3.2,4.2), with all four comparative studies showing enhanced targeting accuracy compared to free-hand targeting. Weighted average overall complications, major complications and mortality were 11.4% (6.7, 16.1), 3.4% (2.1, 5.1) and 0.8% (0.5, 1.3). Pooled estimates of primary technique efficacy were 94% (89, 97) if assessed at 1 – 6 weeks and 90% (87, 93) if assessed at 6 – 12 weeks post ablation, with significant remaining between-study heterogeneity. Pooled odds ratio of primary technique efficacy for stereotactic versus free-hand targeting was 1.9 (1.2, 3.2)(n = 6 studies).Conclusions: Advances in stereotactic navigation technologies allow highly precise and safe tumour targeting, potentially leading to enhanced early treatment efficacy. The use of varying definitions and terminology limit comparability of safety and efficacy among studies, highlighting the crucial need for further standardization of follow-up definitions.

show abstract

“…One study considered an Italian setting only, [99][100][101] one a US setting only, 102 and one a Chinese setting only. 103 One further study considered both an Italian and a US setting. 104,105 In three studies the setting was not formally stated.…”

Section: Resources and Costsmentioning

confidence: 99%

“…The model structures adopted in the identified studies varied significantly, with several alternative underlying approaches adopted. These included Markov models, [103][104][105][106]109 semi-Markov models, [99][100][101] and simulation approaches. 107,108 Model structures adopted were typically highly complex, with several using a large number of health states.…”

Section: Resources and Costsmentioning

confidence: 99%

“…Based on the cost-effectiveness evidence identified in our review, several studies reported utility values that may be relevant to any future analysis. [99][100][101][102][103]106,109 However, the provenance of some of the values reported is unclear. 109 In other cases, it is also apparent that the values obtained are taken from patients with liver disease rather than specifically from patients with HCC.…”

Section: Utilities and Quality Of Lifementioning

confidence: 99%

See 1 more Smart Citation

Ablative and non-surgical therapies for early and very early hepatocellular carcinoma: a systematic review and network meta-analysis

Wade,

South,

Anwer

et al. 2023

Health Technol Assess

View full text Add to dashboard Cite

Background A wide range of ablative and non-surgical therapies are available for treating small hepatocellular carcinoma in patients with very early or early-stage disease and preserved liver function. Objective To review and compare the effectiveness of all current ablative and non-surgical therapies for patients with small hepatocellular carcinoma (≤ 3 cm). Design Systematic review and network meta-analysis. Data sources Nine databases (March 2021), two trial registries (April 2021) and reference lists of relevant systematic reviews. Review methods Eligible studies were randomised controlled trials of ablative and non-surgical therapies, versus any comparator, for small hepatocellular carcinoma. Randomised controlled trials were quality assessed using the Cochrane Risk of Bias 2 tool and mapped. The comparative effectiveness of therapies was assessed using network meta-analysis. A threshold analysis was used to identify which comparisons were sensitive to potential changes in the evidence. Where comparisons based on randomised controlled trial evidence were not robust or no randomised controlled trials were identified, a targeted systematic review of non-randomised, prospective comparative studies provided additional data for repeat network meta-analysis and threshold analysis. The feasibility of undertaking economic modelling was explored. A workshop with patients and clinicians was held to discuss the findings and identify key priorities for future research. Results Thirty-seven randomised controlled trials (with over 3700 relevant patients) were included in the review. The majority were conducted in China or Japan and most had a high risk of bias or some risk of bias concerns. The results of the network meta-analysis were uncertain for most comparisons. There was evidence that percutaneous ethanol injection is inferior to radiofrequency ablation for overall survival (hazard ratio 1.45, 95% credible interval 1.16 to 1.82), progression-free survival (hazard ratio 1.36, 95% credible interval 1.11 to 1.67), overall recurrence (relative risk 1.19, 95% credible interval 1.02 to 1.39) and local recurrence (relative risk 1.80, 95% credible interval 1.19 to 2.71). Percutaneous acid injection was also inferior to radiofrequency ablation for progression-free survival (hazard ratio 1.63, 95% credible interval 1.05 to 2.51). Threshold analysis showed that further evidence could plausibly change the result for some comparisons. Fourteen eligible non-randomised studies were identified (n ≥ 2316); twelve had a high risk of bias so were not included in updated network meta-analyses. Additional non-randomised data, made available by a clinical advisor, were also included (n = 303). There remained a high level of uncertainty in treatment rankings after the network meta-analyses were updated. However, the updated analyses suggested that microwave ablation and resection are superior to percutaneous ethanol injection and percutaneous acid injection for some outcomes. Further research on stereotactic ablative radiotherapy was recommended at the workshop, although it is only appropriate for certain patient subgroups, limiting opportunities for adequately powered trials. Limitations Many studies were small and of poor quality. No comparative studies were found for some therapies. Conclusions The existing evidence base has limitations; the uptake of specific ablative therapies in the United Kingdom appears to be based more on technological advancements and ease of use than strong evidence of clinical effectiveness. However, there is evidence that percutaneous ethanol injection and percutaneous acid injection are inferior to radiofrequency ablation, microwave ablation and resection. Study registration PROSPERO CRD42020221357. Funding This award was funded by the National Institute for Health and Care Research (NIHR) Health Technology Assessment (HTA) programme (NIHR award ref: NIHR131224) and is published in full in Health Technology Assessment; Vol. 27, No. 29. See the NIHR Funding and Awards website for further award information.

show abstract

Cost-Effectiveness of Navigated Radiofrequency Ablation for Hepatocellular Carcinoma in China

Abstract: RVS-RFA is a dominant strategy for patients with small HCC unidentifiable in B-mode US, in terms of cost savings and QALYs gained, relative to the conventional US-guided method.

Cited by 3 publications

References 28 publications

Stereotactic and Robotic Minimally Invasive Thermal Ablation of Malignant Liver Tumors: A Systematic Review and Meta-Analysis

Stereotactic and Robotic Minimally Invasive Thermal Ablation of Malignant Liver Tumors: A Systematic Review and Meta-Analysis

Stereotactic and Robotic Minimally Invasive Thermal Ablation of Malignant Liver Tumours - A Systematic Review and Meta-Analysis

Ablative and non-surgical therapies for early and very early hepatocellular carcinoma: a systematic review and network meta-analysis

Contact Info

Product

Resources

About