Objective To compare the cost-effectiveness of radiofrequency ablation (RFA) and open hepatectomy (OH) in the treatment of early-stage primary carcinoma of liver (PCL). Methods From the perspective of medical and health system, according to a randomized controlled clinical trial, the disease progression of patients was classified into three states: stable period, relapse period and death to construct a Markov model. Quality-adjusted life-years (QALY) was used as the output index to calculate the incremental cost-effectiveness ratio and the direct medical cost. The cost data were derived from the median price of medical and health service projects in 8 provinces and cities, and the utility data were derived from published literature. The transition probability of each state is analyzed by using the cohort simulation method, and the incremental cost-utility ratio (ICUR) was calculated for sensitivity analysis to test the stability of the results. Results The 20 cycles of model operation showed that the average life expectancy of RFA group was longer than that of OH group, and the direct medical costs of RFA group and OH group were 408 483 yuan and 1 512 127 yuan, respectively. Compared with the two groups, the benefit value increased by 2.87 QALY, and the incremental cost-benefit ratio was 384 544.94 yuan/QALY. Conclusion The incremental cost-effectiveness ratio of RFA scheme is far below the threshold of willingness to pay of 64 800 /QALY. As can be seen, RFA has significant cost-effectiveness advantages in the treatment of early PCL diseases.

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