Economic model of observation versus immediate resection of hepatic adenomas.

Background and Objectives For small asymptomatic hepatic adenomas (HA), available data are insufficient to establish the superiority of either observation or surgery. We sought to investigate the cost-effectiveness of two initial management strategies. Methods We performed a comparative analysis of two theoretical cohorts of 100 patients with small (<5 cm), asymptomatic HA. Discounted cash flow (DCF) models compared the net present value (NPV) of both treatment options at year 10 under three distinct progression rate scenarios. A break-even (BE) analysis was used to determine the BE point at which the NPV for observation and immediate surgery intersect. Results The NPV for immediate surgery was $1,733,955. The NPV for observation varied between $2,065,315–$2,745,631 for computed tomography (CT), $2,264,575–$2,929,541 for magnetic resonance imaging (MRI), and $802,837–$1,580,413 for ultrasound (US). The BE point was between 6 and 8 years for CT and 5–7 years for MRI. The BE point for US was not reached except in the highest progression rate scenario (12 years). Conclusions This study highlights the importance of the underlying progression rate and the cost of imaging when following patients with asymptomatic HA. Overall, US surveillance is the most cost-efficient approach to observing small asymptomatic HA. If cross-sectional imaging is utilized, then immediate surgery is the most cost-effective decision at 5–8 years. J. Surg. Oncol. 2012; 106:491–497. © 2012 Wiley Periodicals, Inc.