Recommended Ten Years' Follow-Up Strategy for Small Hepatocellular Carcinoma after Radiofrequency Ablation: A Cost-Effectiveness Evaluation.

OBJECTIVES: An optimal follow-up schedule for small (≤3 cm) hepatocellular carcinoma (HCC) after radiofrequency ablation (RFA) remains unclear in clinical guidelines. We aimed to assess the cost-effectiveness of follow-up strategies in patients with small HCC after RFA.

METHODS: In total, 11,243 patients were collected from global institutions to calculate recurrence rates. Subsequently, a Markov model covering a 10-year period was developed to compare 25 surveillance strategies involving different surveillance techniques (computed tomography [CT], magnetic resonance imaging or ultrasonography [US] and alpha-fetoprotein [AFP]) and intervals (3 or 6 months). The study endpoint was incremental cost-effectiveness ratio (ICER), which represented additional cost per incremental quality-adjusted life-year (QALY). Sensitivity analysis was conducted by varying the values of input parameters to observe the ICER.

RESULTS: In a base case analysis, the dominant strategy was CT every three months during an initial two years, followed by semi-annual CT, and then switch to biannual the combination of US screening and AFP testing after five years (m3_CT-m6_CT-m6_USAFP), with an ICER of $68,570.92 compared to the "not followed" strategy. One-way sensitivity analysis showed the ICER consistently remained below the willingness-to-pay (WTP) threshold of $100,000.00. In a probabilistic sensitivity analysis, m3_CT-m6_CT-m6_USAFP was the most cost-effective approach in 95.6% of simulated scenarios at a WTP threshold.

CONCLUSIONS: For small HCC after RFA, the recommended follow-up strategy is CT, with scans scheduled every three months for the first two years, every six months thereafter, and transition to biannual the combination of US screening and AFP testing after five years.