Adjuvant therapy cost effective for liver cancer patients awaiting transplant

By Will Boggs, MD

NEW YORK (Reuters Health) – For patients with hepatocellular cancer who are facing waiting times of a year or more for liver transplants, adjuvant therapy offers a cost-effective gain in life expectancy, according to a report in the January issue of Gut.

Liver transplantation offers excellent results for patients with limited hepatocellular cancer, the authors explain. Unfortunately, many patients progress beyond a limited stage while awaiting liver transplants.

Dr. Josep M. Llovet from Barcelona-Clinic Liver Cancer Group at the University of Barcelona, Spain, and colleagues designed a decision analysis model to examine whether adjuvant antitumor therapies, including surgical resection and percutaneous ablation, were cost effective in patients with hepatocellular cancer awaiting orthotopic liver transplantation.

Patients who underwent surgical resection saw an increase in transplantation rates from 3.7% for 6-month waiting lists to 10.7% for 24-month waiting lists, the authors report. Similarly, percutaneous ablation increased transplantation rates for all waiting times.

Both adjuvant therapies brought increases in survival probabilities, the report indicates.

Resection provided clinically relevant net gains in life expectancy if waiting times exceeded 6 months, the researchers note, and the marginal cost per year of life saved fell below $40,000 for lists of 12 to 24 months.

Percutaneous ablation was also cost effective, the researchers calculate, achieving clear gains in life expectancy with cost effectiveness ratios below $23,000 per year of life saved.

"Considering the increasing enlargement of waiting time in Europe and the US due to the shortage of donors, the results of our cost effectiveness study demonstrate that adjuvant therapy during the waiting list for liver transplantation is cost-effective when the waiting time exceeds one year in all scenarios tested," Dr. Llovet told Reuters Health.

"Percutaneous ethanol injection [ablation] may be cost effective in shorter waiting times, and its use should be recommended," he added, saying, "Randomized controlled trials are needed in this field."

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