Cost-effectiveness of hepatic resection versus percutaneous radiofrequency ablation for early hepatocellular carcinoma
TL;DR: For very early HCC and in the presence of two or three nodules ≤3 cm, RFA is more cost-effective than resection; for single larger early stage HCCs, surgical resection remains the best strategy to adopt as a result of better survival rates at an acceptable increase in cost.
About: This article is published in Journal of Hepatology.The article was published on 2013-08-01. It has received 287 citations till now. The article focuses on the topics: Early Hepatocellular Carcinoma & Milan criteria.
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TL;DR: The following Clinical Practice Guidelines will give up-to-date advice for the clinical management of patients with hepatocellular carcinoma, as well as providing an in-depth review of all the relevant data leading to the conclusions herein.
7,851 citations
Cites background or methods from "Cost-effectiveness of hepatic resec..."
...with resection and 4,424 patients treated with ablation) with an associated cost-effectiveness analysis using a Markov model concluded that, for very early HCC (single nodule <2 cm) in Child-Pugh class A patients, RFA provided similar life expectancy and quality-adjusted life expectancy at a lower cost.(218) Finally, several cohort studies have reported five-year survival beyond 70% after RFA in well-selected patients with very early HCC....
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...OS in very early HCC (<2 cm) treated by RFA was demonstrated to be at least equal to surgical treatment in a Markov model(299) and in a cost-effective analysis based on data from a systematic review.(218)...
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...in single HCC above 3 cm, while uncertainty still remains for nodules 2–3 cm in size.(218) Also, from the perspective of interventional radiology, competitive local control and long-term...
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...A meta-analysis showed OS of 76% at three years for single HCCs <3 cm, with recurrence-free rates of 46%.(218) Significant predictors of poor OS are Child-Pugh class B, elevated serum alpha-fetoprotein level, and presence of portosystemic collaterals....
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...literature, RFA was shown to be the most cost-effective therapeutic strategy in very early HCC (single nodule <2 cm) and in the presence of two or three nodules ≤3 cm.(218) When deciding between surgery and ablation, it must be considered that similar prognostic factors affect RFA and surgery, namely liver dysfunction and tumour size, but with significantly different...
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University of Tokyo1, National Taiwan University2, Kindai University3, New Generation University College4, Capital Medical University5, Yonsei University6, Post Graduate Institute of Medical Education and Research7, Juntendo University8, Aga Khan University9, Memorial Hospital of South Bend10, Chiba University11, University of Indonesia12, Teikyo University13, Ankara University14
TL;DR: The latest guidelines for the treatment of HCC recommend evidence-based management and are considered suitable for universal use in the Asia–Pacific region, which has a diversity of medical environments.
Abstract: There is great geographical variation in the distribution of hepatocellular carcinoma (HCC), with the majority of all cases worldwide found in the Asia–Pacific region, where HCC is one of the leading public health problems. Since the “Toward Revision of the Asian Pacific Association for the Study of the Liver (APASL) HCC Guidelines” meeting held at the 25th annual conference of the APASL in Tokyo, the newest guidelines for the treatment of HCC published by the APASL has been discussed. This latest guidelines recommend evidence-based management of HCC and are considered suitable for universal use in the Asia–Pacific region, which has a diversity of medical environments.
1,402 citations
Cites background from "Cost-effectiveness of hepatic resec..."
...RFA may be more costeffective than surgical resection [504]....
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TL;DR: Studies now aim to identify molecular markers and imaging techniques that can detect patients with HCC at earlier stages and better predict their survival time and response to treatment.
1,260 citations
TL;DR: In this paper, the authors present those that have primed a change in the strategy and comment why some encouraging data in select interventions are still considered immature and in need to further research to gain their incorporation into an evidence-based model for clinicians and researchers.
774 citations
References
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TL;DR: This paper examines eight published reviews each reporting results from several related trials in order to evaluate the efficacy of a certain treatment for a specified medical condition and suggests a simple noniterative procedure for characterizing the distribution of treatment effects in a series of studies.
33,234 citations
"Cost-effectiveness of hepatic resec..." refers background in this paper
...The meta-analysis was carried out with patient and disease-free survival (DFS) as the main outcome measures, using R-project (version 2.13.0; The R Foundation for Statistical Computing) and applying statistical approaches suggested by Hozo Journal of Hepatology 201 and DerSimonian and Laird [13,14]....
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...Journal of Hepatology 201 and DerSimonian and Laird [13,14]....
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TL;DR: An Explanation and Elaboration of the PRISMA Statement is presented and updated guidelines for the reporting of systematic reviews and meta-analyses are presented.
Abstract: Systematic reviews and meta-analyses are essential to summarize evidence relating to efficacy and safety of health care interventions accurately and reliably. The clarity and transparency of these reports, however, is not optimal. Poor reporting of systematic reviews diminishes their value to clinicians, policy makers, and other users.
Since the development of the QUOROM (QUality Of Reporting Of Meta-analysis) Statement—a reporting guideline published in 1999—there have been several conceptual, methodological, and practical advances regarding the conduct and reporting of systematic reviews and meta-analyses. Also, reviews of published systematic reviews have found that key information about these studies is often poorly reported. Realizing these issues, an international group that included experienced authors and methodologists developed PRISMA (Preferred Reporting Items for Systematic reviews and Meta-Analyses) as an evolution of the original QUOROM guideline for systematic reviews and meta-analyses of evaluations of health care interventions.
The PRISMA Statement consists of a 27-item checklist and a four-phase flow diagram. The checklist includes items deemed essential for transparent reporting of a systematic review. In this Explanation and Elaboration document, we explain the meaning and rationale for each checklist item. For each item, we include an example of good reporting and, where possible, references to relevant empirical studies and methodological literature. The PRISMA Statement, this document, and the associated Web site (http://www.prisma-statement.org/) should be helpful resources to improve reporting of systematic reviews and meta-analyses.
25,711 citations
TL;DR: It is concluded that H and I2, which can usually be calculated for published meta-analyses, are particularly useful summaries of the impact of heterogeneity, and one or both should be presented in publishedMeta-an analyses in preference to the test for heterogeneity.
Abstract: The extent of heterogeneity in a meta-analysis partly determines the difficulty in drawing overall conclusions. This extent may be measured by estimating a between-study variance, but interpretation is then specific to a particular treatment effect metric. A test for the existence of heterogeneity exists, but depends on the number of studies in the meta-analysis. We develop measures of the impact of heterogeneity on a meta-analysis, from mathematical criteria, that are independent of the number of studies and the treatment effect metric. We derive and propose three suitable statistics: H is the square root of the chi2 heterogeneity statistic divided by its degrees of freedom; R is the ratio of the standard error of the underlying mean from a random effects meta-analysis to the standard error of a fixed effect meta-analytic estimate, and I2 is a transformation of (H) that describes the proportion of total variation in study estimates that is due to heterogeneity. We discuss interpretation, interval estimates and other properties of these measures and examine them in five example data sets showing different amounts of heterogeneity. We conclude that H and I2, which can usually be calculated for published meta-analyses, are particularly useful summaries of the impact of heterogeneity. One or both should be presented in published meta-analyses in preference to the test for heterogeneity.
25,460 citations
"Cost-effectiveness of hepatic resec..." refers background in this paper
...Statistical heterogeneity was explored by inconsistency (I(2)) statistics [15]....
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TL;DR: A checklist contains specifications for reporting of meta-analyses of observational studies in epidemiology, including background, search strategy, methods, results, discussion, and conclusion should improve the usefulness ofMeta-an analyses for authors, reviewers, editors, readers, and decision makers.
Abstract: ObjectiveBecause of the pressure for timely, informed decisions in public health
and clinical practice and the explosion of information in the scientific literature,
research results must be synthesized. Meta-analyses are increasingly used
to address this problem, and they often evaluate observational studies. A
workshop was held in Atlanta, Ga, in April 1997, to examine the reporting
of meta-analyses of observational studies and to make recommendations to aid
authors, reviewers, editors, and readers.ParticipantsTwenty-seven participants were selected by a steering committee, based
on expertise in clinical practice, trials, statistics, epidemiology, social
sciences, and biomedical editing. Deliberations of the workshop were open
to other interested scientists. Funding for this activity was provided by
the Centers for Disease Control and Prevention.EvidenceWe conducted a systematic review of the published literature on the
conduct and reporting of meta-analyses in observational studies using MEDLINE,
Educational Research Information Center (ERIC), PsycLIT, and the Current Index
to Statistics. We also examined reference lists of the 32 studies retrieved
and contacted experts in the field. Participants were assigned to small-group
discussions on the subjects of bias, searching and abstracting, heterogeneity,
study categorization, and statistical methods.Consensus ProcessFrom the material presented at the workshop, the authors developed a
checklist summarizing recommendations for reporting meta-analyses of observational
studies. The checklist and supporting evidence were circulated to all conference
attendees and additional experts. All suggestions for revisions were addressed.ConclusionsThe proposed checklist contains specifications for reporting of meta-analyses
of observational studies in epidemiology, including background, search strategy,
methods, results, discussion, and conclusion. Use of the checklist should
improve the usefulness of meta-analyses for authors, reviewers, editors, readers,
and decision makers. An evaluation plan is suggested and research areas are
explored.
17,663 citations
"Cost-effectiveness of hepatic resec..." refers methods in this paper
...[6,12] Other details about meta-analysis approach are reported in the Supplementary Materials and methods....
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TL;DR: This Explanation and Elaboration document explains the meaning and rationale for each checklist item and includes an example of good reporting and, where possible, references to relevant empirical studies and methodological literature.
8,021 citations