Trans-arterial radioembolization for intermediate-advanced hepatocellular carcinoma: a budget impact analysis

Abstract

BackgroundTrans-arterial radio-embolization (TARE) is an emerging treatment for the management of hepatocellular carcinoma (HCC). TARE may compete with systemic chemotherapy, sorafenib, in intermediate stage patients with prior chemoembolization failure or advanced patients with tumoral macrovascular invasion with no extra-hepatic spread and good liver function.We performed a budget impact analysis (BIA) evaluating the expected changes in the expenditure for the Italian Healthcare Service within scenarios of increased utilization of TARE in place of sorafenib over the next five years.MethodsStarting from patient level data from three oncology centres in Italy, a Markov model was developed to project on a lifetime horizon survivals and costs associated to matched cohorts of intermediate-advanced HCC patients treated with TARE or sorafenib. The initial model has been integrated with epidemiological data to perform a BIA comparing the current scenario with 20 and 80% utilization rates for TARE and sorafenib, respectively, with increasing utilization rates of TARE of 30, 40 and 50% over the next 1, 3 and 5 years.ResultsCompared to the current scenario, progressively increasing utilization rates of TARE over sorafenib in the next 5 years is expected to save globally about 7 million Euros.ConclusionsRadioembolization can be considered a valuable treatment option for patients with intermediate-advanced HCC. These findings enrich the evidence about the economic sustainability of TARE in comparison to standard systemic chemotherapy within the context of a national healthcare service.Electronic supplementary materialThe online version of this article (10.1186/s12885-018-4636-7) contains supplementary material, which is available to authorized users.

Efficacy of Regorafenib in Hepatocellular Carcinoma Patients: A Systematic Review and Meta-Analysis

“…Of note, all of the included studies recruited patients who progressed on sorafenib, therefore the eventual role of regorafenib in the first-line setting is unknown. Further studies are needed in order to evaluate the competitive role of regorafenib with other systemic agents [24], in particular sorafenib, and with transarterial radioembolization in intermediate/advanced HCC patients with portal vein invasion [25][26][27].…”

A cost analysis of SIR-Spheres yttrium-90 resin microspheres versus tyrosine kinase inhibitors in the treatment of unresectable hepatocellular carcinoma in France, Italy, Spain and the UK

“…In the Italian setting, two recently-published studies of locoregional therapies for HCC in Italy were used to inform the cost collection exercise, and unit costs were crosschecked against health economic studies of metastatic melanoma in Italy [29][30][31][32] published by Vouk et al 31 and Wehler et al 32 in 2016 and 2018, respectively. Drug costs in the Italian setting were taken from the Gazzetta Ufficiale either at the time of the approval or the most recent ex-factory price update for sorafenib, lenvatinib and regorafenib [33][34][35] .…”

Effect of microwave ablation treatment of hepatic malignancies on serum cytokine levels

“…In China, hepatocellular carcinoma (HCC) has the second highest mortality rate of malignancies [1]. The treatment of primary and secondary hepatic malignancies via interventional imaging therapy is undertaken by investigators in the field of interventional radiology and possibly by a smaller group of practitioners known as interventional oncologists, whose major focus is cancer care via minimally invasive approaches [2,3]. Recently, percutaneous ablation therapy has been widely accepted as a radical treatment method for HCC, and its five-year survival rate is similar to that of resection [4].…”