Utility-based criteria for selecting patients with hepatocellular carcinoma for liver transplantation: A multicenter cohort study using the alpha-fetoprotein model as a survival predictor

Alessandro Vitale, Fabio Farinati, Patrizia Burra, Franco Trevisani, Edoardo G. Giannini, Francesca Ciccarese, Fabio Piscaglia, Gian Lodovico Rapaccini, Mariella Di Marco, Eugenio Caturelli, Marco Zoli, Franco Borzio, Giuseppe Cabibbo, Martina Felder, Rodolfo Sacco, Filomena Morisco, Gabriele Missale, Francesco Giuseppe Foschi, Antonio Gasbarrini, Gianluca Svegliati BaroniRoberto Virdone, Maria Chiaramonte, Gaya Spolverato, Umberto Cillo

Research output: Contribution to journalArticle

Abstract

The lifetime utility of liver transplantation (LT) in patients with hepatocellular carcinoma (HCC) is still controversial. The aim of this study was to ascertain when LT is cost-effective for HCC patients, with a view to proposing new transplant selection criteria. The study involved a real cohort of potentially transplantable Italian HCC patients (n = 2419 selected from the Italian Liver Cancer group database) who received nontransplant therapies. A non-LT survival analysis was conducted, the direct costs of therapies were calculated, and a Markov model was used to compute the cost utility of LT over non-LT therapies in Italian and US cost scenarios. Post-LT survival was calculated using the alpha-fetoprotein (AFP) model on the basis of AFP values and radiological size and number of nodules. The primary endpoint was the net health benefit (NHB), defined as LT survival benefit in quality-adjusted life years minus incremental costs (US $)/willingness to pay. The calculated median cost of non-LT therapies per patient was US $53,042 in Italy and US $62,827 in the United States. On Monte Carlo simulation, the NHB of LT was always positive for AFP model values ≤ 3 and always negative for values > 7 in both countries. A multivariate model showed that nontumor variables (patient's age, Child-Turcotte-Pugh [CTP] class, and alternative therapies) had the potential to shift the AFP model threshold of LT cost-ineffectiveness from 3 to 7. LT proved always cost-effective for HCC patients with AFP model values ≤ 3, whereas the cost-ineffectiveness threshold ranged between 3 and 7 using nontumor variables. 2015 American Association for the Study of Liver Diseases.

Original languageEnglish
Pages (from-to)1250-1258
Number of pages9
JournalLiver Transplantation
Volume21
Issue number10
DOIs
Publication statusPublished - Oct 1 2015

ASJC Scopus subject areas

  • Surgery
  • Transplantation
  • Hepatology

Fingerprint Dive into the research topics of 'Utility-based criteria for selecting patients with hepatocellular carcinoma for liver transplantation: A multicenter cohort study using the alpha-fetoprotein model as a survival predictor'. Together they form a unique fingerprint.

  • Cite this

    Vitale, A., Farinati, F., Burra, P., Trevisani, F., Giannini, E. G., Ciccarese, F., Piscaglia, F., Rapaccini, G. L., Di Marco, M., Caturelli, E., Zoli, M., Borzio, F., Cabibbo, G., Felder, M., Sacco, R., Morisco, F., Missale, G., Foschi, F. G., Gasbarrini, A., ... Cillo, U. (2015). Utility-based criteria for selecting patients with hepatocellular carcinoma for liver transplantation: A multicenter cohort study using the alpha-fetoprotein model as a survival predictor. Liver Transplantation, 21(10), 1250-1258. https://doi.org/10.1002/lt.24214