Cost Effectiveness of Radioembolization Compared with Conventional Transarterial Chemoembolization for Treatment of Hepatocellular Carcinoma

Rostambeigi, Nassir; Dekarske, Adrienne S.; Austin, Erin; Golzarian, Jafar; Cressman, Erik N.K.

doi:10.1016/j.jvir.2014.04.014

Cited by 53 publications

(51 citation statements)

References 66 publications

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“…cost-effectiveness) of TARE vs. sorafenib and help in this setting to assess the value of presumably similar treatment options in field practice. In a recent cost-effectiveness analysis of TARE vs. TACE, patients with advanced BCLC-C were found to benefit from radioembolization at an increased cost [46] while in patients with BCLC-A disease, who formally lack survival benefit from radioembolization, cost-efficacy could be obtained in some specific subgroups, such as PVT or technical unfeasibility of curative approaches. In the future, a cost-effectiveness analysis could be performed comparing TARE with the other available therapies, particularly sorafenib, to identify whether this procedure is cost-effective or not, and to profile HCC subgroups which could benefit from TARE at a reasonable cost.…”

Section: Discussionmentioning

confidence: 99%

Trans-arterial radioembolization in intermediate-advanced hepatocellular carcinoma: systematic review and meta-analyses

et al. 2016

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Trans-arterial radioembolization (TARE) is a recognized, although not explicitly recommended, experimental therapy for unresectable hepatocellular carcinoma (HCC).A systematic literature review was performed to identify published studies on the use of TARE in intermediate and advanced stages HCC exploring the efficacy and safety of this innovative treatment.Twenty-one studies reporting data on overall survival (OS) and time to progression (TTP), were included in a meta-analysis. The pooled post-TARE OS was 63% (95% CI: 56-70%) and 27% (95% CI: 21-33%) at 1- and 3-years respectively in intermediate stage HCC, whereas OS was 37% (95% CI: 26-50%) and 13% (95% CI: 9-18%) at the same time intervals in patients with sufficient liver function (Child-Pugh A-B7) but with an advanced HCC because of the presence of portal vein thrombosis. When an intermediate and advanced case-mix was considered, OS was 58% (95% CI: 48-67%) and 17% (95% CI: 12-23%) at 1- and 3-years respectively. As for TTP, only four studies reported data: the observed progression probability was 56% (95% CI: 41-70%) and 73% (95% CI: 56-87%) at 1 and 2 years respectively. The safety analysis, focused on the risk of liver decompensation after TARE, revealed a great variability, from 0-1% to more than 36% events, influenced by the number of procedures, patient Child-Pugh stage and treatment duration.Evidence supporting the use of radioembolization in HCC is mainly based on retrospective and prospective cohort studies. Based on this evidence, until the results of the ongoing randomized trials become available, radioembolization appears to be a viable treatment option for intermediate-advanced stage HCC.

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Section: Discussionmentioning

confidence: 99%

Trans-arterial radioembolization in intermediate-advanced hepatocellular carcinoma: systematic review and meta-analyses

et al. 2016

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“…Multiple retrospective or noncontrolled prospective studies (levels of evidence II-2 and II-3) support the use of radioembolization, but no randomized controlled trials have been published comparing radioembolization with other locoregional versus systemic therapies versus best supportive care (Sangro et al 2012). Recently, a cost-effectiveness analysis suggested that radioembolization costs may be justified for patients with BCLC stage C disease, whereas radioembolization may not be cost effective in patients with BCLC stage A disease (Rostambeigi et al 2014). Current indications of Y-90-radioembolization include intermediate stage patients with bulky or bilobar disease, which are considered poor candidates for TACE, and advanced patients with solitary tumors invading a segmental or lobar branch of the portal vein.…”

Section: Treatment For Intermediate Stage Tacementioning

confidence: 99%

Treatment of Liver Cancer

Liu

Chen

2015

Cold Spring Harb Perspect Med

253

180

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Primary liver cancer, mostly hepatocellular carcinoma, remains a difficult-to-treat cancer. Incidence of liver cancer varies geographically and parallels with the geographic prevalence of viral hepatitis. A number of staging systems have been developed, reflecting the heterogeneity of primary liver cancer, regional preferences, and regional variations in resectability or transplant eligibility. Multimodality treatments are available for this heterogeneous malignancy, and there are variations in the management recommendations for liver cancers across specialties and geographic regions. Novel treatment strategies have merged with the advance of new treatment modalities. This work focuses on reviewing the incidence, staging, and treatment of liver cancer.

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“…A comparison study of radioembolization with drug eluting beads has shown no significant difference in progression-free survival, overall survival and time to progression [35] Radioembolization is US FDA approved for the treatment of HCC and is preferably used in patients with portal thrombosis, or biliary obstruction [33,34]. Costeffectiveness studies of radioembolization versus c-TACE indicate that the former may be justified for BCLC-C disease but not for BCLC-A disease [36]. For BCLC-B disease more randomized studies comparing drug eluting beads and radioembolization are needed.…”

Section: Indications Guidelines and Technical Recommendationsmentioning

confidence: 99%

Chemoembolization of hepatocellular carcinoma with HepaSphere™

et al. 2015

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This review discusses the current data on Hepasphere™ in the treatment of hepatocellular carcinoma. HepaSphere is a drug-loadable microsphere that can be bound with doxorubicin, epirubicin, cisplatin or oxaliplatin. and studies confirm lower systemic exposure to the drug and fewer systemic doxorubicin-related side effects. Studies suggest that this technique is better tolerated than conventional lipiodol-based chemoembolization (c-TACE). In intermediate and early stage hepatocellular carcinoma - nonresponsive to curative treatments - complete response and partial response rates range from 22.2 to 48% and 43.7 to 51%, respectively. Studies with survival as an end-point are needed and head-to-head comparisons with other drug-eluting beads are necessary.

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Cost Effectiveness of Radioembolization Compared with Conventional Transarterial Chemoembolization for Treatment of Hepatocellular Carcinoma

Cited by 53 publications

References 66 publications

Trans-arterial radioembolization in intermediate-advanced hepatocellular carcinoma: systematic review and meta-analyses

Trans-arterial radioembolization in intermediate-advanced hepatocellular carcinoma: systematic review and meta-analyses

Treatment of Liver Cancer

Chemoembolization of hepatocellular carcinoma with HepaSphere™

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