Cost-effectiveness of selective internal radiation therapy using yttrium-90 resin microspheres in treating patients with inoperable colorectal liver metastases in the UK

Figures & data

Table 1. Patient characteristics.

Variable	Patients
	SIRT	BSC	p Value
Total	223	29
Age			0.46
≤65 years	0.56	0.66
>65 years	0.44	0.34
Average age (years)	66.9	69
Sex			0.07
Male	0.63	0.79
Female	0.37	0.21
Previous systemic chemotherapy	0.94	0.93	1.00
Previous local liver treatment	0.27	0.24	0.90
Hepatic tumor burden*			0.58
≤25%	0.57	0.64
>25%	0.43	0.36
26–50%*	0.35	0.32
>50%	0.09	0.04

*Both patient groups (i.e., patients with 26–50% hepatic tumor burden and patients with more than 50% tumor burden) have been summarized or included, or both, in the group of patients with hepatic tumor burden of more than 25% for analysis purposes.

SIRT, selective internal radiation therapy; BSC, best supportive care.

Figure 1. Overall survival curves for best supportive care and selective internal radiation therapy. BSC, best supportive care; SIRT, selective internal radiation therapy.

Table 2. Summary of input values.

Parameter	Mean	SD	Range for 1WSA	Distribution for PSA	Source
Model Settings
Discount rate – costs	3.50%	N/A	N/A	N/A	Seidensticker et al.5
Discount rate – benefits	3.50%	N/A	N/A	N/A	Seidensticker et al.5
Utility values
Pre-progression utility	0.75	0.04	0.67–0.83*	Beta (75,25)	Bester et al.6
Post-progression utility	0.69	0.04	0.60–0.78*	Beta (69,31)	Bester et al.6
Utility decrement before death	0.1	0.03	0.00–0.50*	Beta (10,90)	Assumption
Efficacy
Proportion of time in pre-progression	0.5	0.05	0.25–0.75	Beta (50,50)	Assumption
Overall survival – shape parameter	0.75		0.48–1.18	Multivariate normal	Survival analysis4
Overall survival – BSC scale parameter	5.12		4.47–5.76
Overall survival – SIRT scale parameter	5.37		4.21–6.54
Costs
SIRT work-up and procedure	£14,248		£14,246–£14,250	Normal (14248,0.42)	Akaike9
Stomatitis	£188	£18.80	£151–£225	Normal (188,19)	NHS11
Anorexia	£132	£13.20	£106–£158	Normal (132,13)	NICE12
Fatigue	£19	£1.90	£15–£23	Normal (19,2)	NHS11
Hand-foot syndrome	£156	£15.60	£125–187	Normal (156,16)	NICE12
Dyspnoea	£187	£18.71	£150–£224	Normal (187,19)	Akaike9
Pulmonary	£187	£18.71	£150–£224	Normal (187,19)
Allergy	£147	£14.69	£118–£176	Normal (147,15)
Oncology appointment cost	£121	£0.03	£121–£122	Normal (122,0.03)
Daily treatment costs – SIRT	£17	N/A	N/A	N/A	Hendlisz et al.3; NICE14
Daily treatment costs – BSC	£16	N/A	N/A	N/A
Death cost	£5800	£580.00	£4663–£6937	Normal (5800,580)	NICE15; Joint Formulary Committee16

*Range determined as 95% confidence intervals from corresponding beta distribution.

SIRT, selective internal radiation therapy; BSC, best supportive care; 1WSA, one-way sensitivity analysis; PSA, probabilistic sensitivity analysis.

Table 3. Base case and scenario analysis results.

	Total			Incremental			ICER
	Cost	QALYs	LYs	Cost	QALYs	LYs
Base case
BSC	£12,730	0.69	0.97
SIRT	£35,487	1.5	2.09	£22,757	0.81	1.12	£28,216
Sensitivity analysis – stratified log-normal curve
BSC	£12,582	0.67	0.95
SIRT	£35,547	1.5	2.1	£22,965	0.83	1.15	£27,749
Sensitivity analysis – 25% of time spent in pre-progression
BSC	£12,730	0.68	0.97
SIRT	£35,487	1.47	2.09	£22,757	0.79	1.12	£28,817
Sensitivity analysis – 75% of time spent in pre-progression
BSC	£12,730	0.7	0.97
SIRT	£35,487	1.53	2.09	£22,757	0.82	1.12	£27,641
Sensitivity analysis – Utilities based on time since diagnosis17
BSC	£12,730	0.79	0.97
SIRT	£35,487	1.7	2.09	£22,757	0.91	1.12	£25,015
Sensitivity analysis – no utility decrement before death
BSC	£12,730	0.7	0.97
SIRT	£35,487	1.5	2.09	£22,757	0.81	1.12	£28,226
Sensitivity analysis – utility decrement of 0.5 before death
BSC	£12,730	0.66	0.97
SIRT	£35,487	1.47	2.09	£22,757	0.81	1.12	£28,178
Sensitivity analysis – costs of adverse events excluded
BSC	£12,688	0.70	1.03
SIRT	£35,479	1.53	2.38	£22,792	0.82	1.35	£27,683

QALYs, quality-adjusted life years; LYs, life years; ICER, incremental cost-effectiveness ratio; SIRT, selective internal radiation therapy; BSC, best supportive care.

Figure 2. Tornado diagram. BSC, best supportive care; SIRT, selective internal radiation therapy.

Figure 3. Cost-effectiveness probabilistic sensitivity analysis scatterplot and cost-effectiveness acceptability curve. BSC, best supportive care; SIRT, selective internal radiation therapy.

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