Erce & Parks 2003 SR UK 8 primary studies on HCC and secondary tumours Cryoablation, RFA, MTA, ILP, ethanol ablation, other injections HCC and CRC tumours At this time, MTA of liver had primarily been used to treat HCC. Complete necrosis is possible in tumours <2cm. Recurrence was low. Garcea et al. 2003 SR UK 2 primary studies on primary and secondary tumours Ten types of ablation Primary and secondary tumours Studies on treatment of secondary and primary cancer with PEI, percutaneous acetic acid injection, other percutaneous injections, RFA, high-intensity focused ultrasound (HIFU), interstitial laser photocoagulation (ILP), MTA, electrolysis and cryotherapy. Two studies reported on MTA use in the liver. Fair therapeutic results were achieved with MTA in lesions of 30 mm or less, and in well differentiated HCCs. HCC = hepatocellular carcinoma; HIFU = high-intensity focused ultrasound; ILP = interstitial laser photocoagulation; MHz = Megahertz; MTA = microwave tissue ablation; PEI = percutaneous ethanol injection; RFA = radiofrequency ablation; SR = systematic review; UK = United Kingdom; USA = United States of America Table 3 Included systematic reviews on primary liver cancer Study ID Study type Location Evidence level of included studies Interventions Population Key outcomes Weiss et al. 2013 SR Germany 1 level II study on HCC RFA, resection*, PEI, laser ablation and MTA HCC Included one RCT on RFA versus microwave ablation (one trial, 72 participants). No significant difference was found between RFA and percutaneous MTA regarding local progression. Rate of complications in both groups was low. *Included Shibata et al. 2002 only; HCC = hepatocellular carcinoma; ILP = interstitial laser photocoagulation; MTA = microwave tissue ablation; PEI = percutaneous ethanol injection; RCT = randomised controlled trial; RFA = radiofrequency ablation; SR = systematic review
Table 18 List of resources to be considered in the economic analysis Provider of resource Setting in which resource is provided Proportion of patients receiving resource Number of units of resource per relevant time horizon per patient receiving resource Disaggregated unit cost MBS Item Safety nets* Other government budget Private health insurer Patient Total cost Resources provided to identify eligible population Diagnostic imaging (US, CT, CECT, MRI etc.) Radiologists Radiology clinic or radiology department (hospital) 100% 55036 (US abdomen), 56407, 56447 (CT abdomen) Liver function tests Pathology laboratory unknown 66515 Biopsy Hepatologists or radiologists Out-patient hospital unknown 30409 Resources provided to deliver proposed intervention (MTA) Machine cost ($50,000) Hospital In-patient 100% NA Disposable probe ($2,960) Hospital In-patient 100% NA Time to perform procedure (ablation time of 4-6 minutes per lesion, also time for patient positioning, anaesthetic administration)^ Interventional radiologist or surgeon Radiology suite or operating theatre 100% (split between two services not known) NA Imaging (CT or US) Interventional radiologist or surgeon Radiology suite or operating theatre 100% (split between two services not known) 55036 (US abdomen), 56407, 56447 (CT abdomen)
Anaesthetic Anaesthetist Radiology suite or operating theatre 100% 17610- 17625 (initial consult) 21922 (anaesthesia management) Resources provided in association with proposed intervention (MTA) Aftercare Dedicated nursing staff In-patient 100% NA Follow-up imaging 3 to 6 weeks Radiologist/radiographer Radiology clinic or radiology department 100% 56407, 56447 (CT abdomen) Resources provided to deliver comparator 1 (RFA) Machine cost Hospital In-patient (laparoscopic or open). Out-patient (percutaneous)** 100% NA Disposable probe Hospital In-patient (laparoscopic or open). Out-patient (percutaneous)** 100% NA Time to perform ablation (10-20 minutes) Interventional radiologist or surgeon Radiology suite or operating theatre 100%^^ 50950 (percutaneous) 50952 (open or laparoscopic)
Imaging (CT or US) Interventional radiologist or surgeon Radiology suite or operating theatre 100%^^ 55036 (US abdomen), 56407, 56447 (CT abdomen) Anaesthetic Anaesthetist Radiology suite or operating theatre 100%^^ 17610- 17625 (initial consult) 21922 (anaesthesia management) Resources provided in association with comparator 1 (RFA) Aftercare Dedicated nursing staff In-patient (laparoscopic/open) or out-patient (percutaneous) 100% NA Follow-up imaging Radiologist/radiographer Radiology clinic or radiology department 100% 56407, 56447 (CT abdomen) Resources used to manage patients successfully treated with the proposed intervention Follow-up imaging to confirm no tumour recurrence Radiologist/radiographer Radiology clinic or radiology department 100% of patient successfully treated Follow-up treatment as required Multidisciplinary team as required Dependant on type of treatment required
Follow-up palliative care as required Multidisciplinary team as required Dependant on type of treatment required Resources used to manage patients who are unsuccessfully treated with the proposed intervention Follow-up imaging to confirm incomplete ablation of tumour and/or tumour recurrence Radiologist/radiographer Radiology clinic or radiology department 100% of patients unsuccessfully treated Re-staging of disease and treatment as determined according to current disease status Multidisciplinary team as required Dependant on type of treatment required 100% of patients unsuccessfully treated Resources used to manage patients successfully treated with comparator 1 Follow-up imaging to confirm no tumour recurrence Radiologist/radiographer Radiology clinic or radiology department 100% of patient successfully treated Follow-up treatment as required Multidisciplinary team as required Dependant on type of treatment required Follow-up palliative care as required Multidisciplinary team as required Dependant on type of treatment required Resources used to manage patients who are unsuccessfully treated with comparator 1