https://orcid.org/0000-0001-8715-2063
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Abstract
Objectives
To assess the cost-effectiveness of transarterial radioembolization (TARE) versus conventional transarterial chemoembolization (cTACE) and drug-eluting beads chemoembolization (DEE-TACE) for patients with unresectable early- to intermediate-stage hepatocellular carcinoma (HCC).
Design
A cohort-based Markov model with a five-year time horizon was developed to evaluate the cost-effectiveness of the three embolization treatments. Upon entering the model, patients with HCC received either TARE or one of the two other embolization treatments. Patients remained in a “watch and wait” state for tumor downstaging that allowed them to move to health states such as liver transplant, resection, systemic therapies, or cure. Clinical input parameters were retrieved from the published literature, and where values could not be sourced, assumptions were made and validated by clinical experts. Health benefits were quantified using quality-adjusted life years (QALYs). Cost input parameters were obtained from various sources, including the Medicare Cost Report, IBM® Micromedex RED BOOK, and published literature.
Results
At five years, TARE was found to be cost-saving (saving $15,779 per person compared to cTACE) and produced 0.33 more QALYs per person than cTACE. TARE cost $13,696 more but produced 0.33 more QALYs than DEE-TACE, with an incremental cost-effectiveness ratio of $41,474 per QALY gained at five years. After accounting for parameter uncertainty, the likelihood of TARE being cost-effective was at least 90% against all comparators at a cost-effectiveness threshold of $100,000 per QALY gained.
Conclusions
TARE produces more QALYs than cTACE and DEE-TACE, with a high probability of being cost-effective against both comparators.
PLAIN LANGUAGE SUMMARY
The Barcelona Clinic Liver Cancer guideline recommends the use of transarterial radioembolization (TARE), conventional (cTACE), or drug-eluting bead transarterial chemoembolization (DEE-TACE) for treating hepatocellular carcinoma (HCC). This study evaluated the cost-effectiveness of TARE versus two alternative embolization treatments (cTACE and DEE-TACE) in treating patients with unresectable early- to intermediate-stage HCC.
A cohort-based Markov model was developed to analyze the costs and benefits of these treatments from a US healthcare perspective within a 5-year time horizon. A 20-year time horizon was assessed as a scenario. In the model, patients were assigned to receive TARE, cTACE, or DEE-TACE and remained in the “watch and wait” stage for tumor downstaging. Data used in the model was taken from previous studies and in consultation with clinical experts. The benefits of the treatments were measured by considering the impact on the patient’s quality of life. The costs associated with the treatments were obtained from various sources, including reports, publicly available databases, and published literature.
The findings show that TARE is not only cost-saving compared to cTACE but also results in a higher number of quality-adjusted life years (QALYs) per person. While TARE was more expensive than DEE-TACE, it produced more QALYs, further indicating more favorable patient outcomes and overall treatment effectiveness. These findings could potentially impact resource allocation and decision-making for the treatment of HCC.
Transparency
Declaration of funding
This study was supported by Boston Scientific.
Declaration of financial/other relationships
AOW and NA are full-time employees of Boston Scientific. OA and MVP are advisors and consultants for Boston Scientific. OA and MVP were not compensated for their participation in this study. HD, TB, HH, and SM are employees of York Health Economics Consortium, a consulting company paid by Boston Scientific for these services (consultancy, economic model adaptation, and drafting the manuscript) rendered. HB was an employee of the York Health Economics Consortium at the time the work was conducted.
Author contributions
HD, HB, TB, SM, and HH were involved in the model design and development. HD, TB, and SM were involved in drafting and editing the manuscript. AW and NA were involved with model validation, data collection, drafting, and editing of the manuscript. MVP and OA were involved with model validation and manuscript editing and revision.
Acknowledgements
The authors would like to acknowledge Rod Martin (for generating cost data), Joe Gardill (for validating cost data), Wendy Wifler, Liesl Hargens, and Alexa Da Silva for validating clinical care pathways of all modalities.
Data availability statement
The data supporting the findings of this study are available upon reasonable request.
Reviewer disclosures
A reviewer on this manuscript has disclosed that they are and have been an employee of consultancy companies, they have received consultancy fees and expenses from Bayer and Sirtex for conducting economic evaluation for sorafenib and SIR-Spheres in advanced HCC, including manuscripts and HTA submissions previously.
Another reviewer has worked as a health economics consultant, I have worked on statistical analyses, economic modelling, manuscripts, HTA submissions for different stages of HCC for multiple products and multiple manufacturers previously. At present, they have no current ongoing work in HCC.
All the peer reviewers on this manuscript have received an honorarium from JME for their review work but have no other relevant financial relationships to disclose.
Previous presentations
This research was submitted and has been accepted for presentation at the Society of Interventional Oncology, Washington, DC, January 19–23, 2023, titled “Five-year Cost-effectiveness Analysis of Y-90 Glass Microspheres & Transarterial Chemotherapies for the Treatment of Intermediate-stage Hepatocellular Carcinoma”. It was also presented as a traditional poster for SIR 2022 Annual Scientific Meeting in Boston, June 11–16, 2022 (abstract number 556, titled “Cost-Effectiveness of Radioembolization with Y90 Glass Microspheres versus Transarterial Chemotherapies in the Treatment of Intermediate Stage Hepatocellular Carcinoma: A US Hospital Perspective”). The abstract can be found here: https://www.jvir.org/article/S1051-0443(22)00696-0/fulltext.