< 0.0001). Compared to patients with CT-guided RFA, those who received US-guided RFA had comparable risk of short-term and long-term postprocedural complications in tumor size-stratified analysis. No statistically significant difference was found in overall survival (CT versus US: HR = 1.21, P = 0.13) and cancer-specific survival (HR = 1.11, P = 0.50). The adjusted complication costs were $11,109 for US-guided RFA, and $11,046 for CT-guided RFA, whereas the procedural cost of CT-guided RFA was significantly higher than US-guided RFA ($2,670 vs. $1,746, P < 0.01). ConClusions: Despite its rapid adoption over time, CT-guided RFA incurred higher procedural costs than the conventional US-guided RFA but did not significantly improve postprocedural complications and survival. Echoing the American Board of Internal Medicine's Choosing Wisely campaign and American Society of Clinical Oncology's Value of Cancer Care initiative, findings from our study call for critical evaluation of whether CT-guided RFA provides high-value care for HCC patients.

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