Radiofrequency Ablation Technology in Liver Malignancies: A Systematic Review of Economic Evaluations.

Background: Liver malignancies, including hepatocellular carcinoma (HCC), present significant treatment challenges, with limited curative options available. Radiofrequency ablation (RFA) has emerged as a minimally invasive therapeutic approach for early-stage HCC, offering comparable survival benefits to surgical resections in some patients. However, the economic implications of RFA relative to other treatment modalities remain a critical factor in decision-making. This study systematically reviews economic evaluations of RFA to assess its viability in managing liver malignancies.

Methods: A systematic review was conducted following the PRISMA guidelines. Databases, including PubMed, Scopus, Web of Science, and Google Scholar, were searched for economic evaluations of RFA published from 2015 onwards. Eligible studies compared RFA with other curative and palliative treatments, focusing on health-related economic outcomes. The primary outcome of the included studies was the incremental cost-effectiveness ratio (ICER).

Results: Ten studies met the inclusion criteria, covering diverse healthcare systems and cost-effectiveness models. The results indicated that RFA is generally more cost-effective than percutaneous ethanol injection [incremental cost: $ - 917, incremental effectiveness: 0.34, ICER: $ - 2675] and laparoscopic hepatectomy [incremental costs: ¥ - 4702, incremental effectiveness: 0] but less cost-effective than microwave ablation [ICER: dominated], liver resection, and transplantation [ICER: between $23,916 and $113,530/QALY] at higher willingness-to-pay thresholds. Comparisons with stereotactic body radiotherapy and surgery yielded mixed results.

Conclusions: RFA is a cost-effective treatment for small HCC tumors, particularly in resource-limited settings. However, its cost-effectiveness declines with increasing tumor size compared to liver transplantation. Further real-world economic evaluations and modeling studies are needed to confirm its affordability across different healthcare settings.