The cost-effectiveness of TheraSphere in patients with hepatocellular carcinoma who are eligible for transarterial embolization

Derek Manas; Jon K Bell; Stuart Mealing; Heather Davies; Hannah Baker; Hayden Holmes; Richard A Hubner

doi:10.1016/j.ejso.2020.08.027

The cost-effectiveness of TheraSphere in patients with hepatocellular carcinoma who are eligible for transarterial embolization

Eur J Surg Oncol. 2021 Feb;47(2):401-408. doi: 10.1016/j.ejso.2020.08.027. Epub 2020 Sep 14.

Authors

Derek Manas¹, Jon K Bell², Stuart Mealing³, Heather Davies⁴, Hannah Baker⁵, Hayden Holmes⁶, Richard A Hubner⁷

Affiliations

¹ Newcastle upon Tyne NHS Trust, Freeman Hospital Freeman Road High Heaton Newcastle upon Tyne, NE7 7DN, UK. Electronic address: derek.manas@nhs.net.
² The Christie NHS Foundation Trust, Wilmslow Rd, Manchester, M20 4BX, UK. Electronic address: Jon.Bell@christie.nhs.uk.
³ York Health Economics Consortium, Enterprise House, University of York, York, YO10 5NQ, UK. Electronic address: stuart.mealing@york.ac.uk.
⁴ York Health Economics Consortium, Enterprise House, University of York, York, YO10 5NQ, UK. Electronic address: heather.r.davies@york.ac.uk.
⁵ York Health Economics Consortium, Enterprise House, University of York, York, YO10 5NQ, UK. Electronic address: hannah.baker@york.ac.uk.
⁶ York Health Economics Consortium, Enterprise House, University of York, York, YO10 5NQ, UK. Electronic address: hayden.holmes@york.ac.uk.
⁷ The Christie NHS Foundation Trust, Wilmslow Rd, Manchester, M20 4BX, UK. Electronic address: Richard.Hubner@christie.nhs.uk.

PMID: 32958370
DOI: 10.1016/j.ejso.2020.08.027

Abstract

Introduction: The aim of the study is to estimate the cost-effectiveness of TheraSphere against other embolic treatments in a population with early to intermediate stage hepatocellular carcinoma (HCC) who are unresectable at presentation and are eligible for transarterial embolization (TAE), conventional transarterial chemoembolization (cTACE) or drug-eluting bead TACE (DEB-TACE).

Materials and methods: A Markov model was constructed using a UK National Health Service (NHS) perspective, a 20-year time horizon, and four-week cycles. The eight health states included 'watch and wait', 'transplantation' (pre-, post and post (No HCC)), 'resection', 'no HCC other', 'pharmacological management' and 'death'. Clinical data were sourced from literature and expert opinion. Resource use and costs were reflective of the NHS, and benefits were quantified using Quality-Adjusted Life Years (QALYs), with utility weights sourced from literature. Comparators were TAE, cTACE and DEB-TACE. The primary output was the Incremental Cost-Effectiveness Ratio (ICER) expressed as cost per QALY gained. An ICER of under £20,000/QALY gained for an intervention is cost-effective and represents efficient use of healthcare resources. Extensive deterministic and probabilistic sensitivity analyses were undertaken.

Results: TheraSphere patients were predicted to gain 0.7 additional QALYs compared to all other treatments. The base case ICERs for TheraSphere were £17,300, £17,279 and £23,020 per QALY gained compared to TAE, cTACE and DEB-TACE, respectively. In the TheraSphere cohort, 87% more patients were predicted to achieve downstaging compared to all other treatment options.

Conclusions: This study indicates that treatment with TheraSphere is a potentially cost-effective option for patients with early to intermediate stage HCC.

Keywords: Bland embolization; Cost-effectiveness; Downstaging to transplant; Health economics; Selective internal radiation therapy; TACE.

Publication types

Research Support, Non-U.S. Gov't

MeSH terms

Aged
Carcinoma, Hepatocellular / diagnosis
Carcinoma, Hepatocellular / therapy*
Chemoembolization, Therapeutic / economics*
Cost-Benefit Analysis
Female
Follow-Up Studies
Humans
Infusions, Intra-Arterial
Liver Neoplasms / diagnosis
Liver Neoplasms / therapy*
Male
Microspheres
Radiopharmaceuticals / administration & dosage*
Treatment Outcome

Substances

Radiopharmaceuticals