Cost-utility analysis of selective internal radiation therapy with Y-90 resin microspheres in hepatocellular carcinoma

Abstract

Lay abstract Hepatocellular carcinoma is a complex disease, where in advanced stages there are limited treatment options. Among patients who are not eligible for liver transplant, removal of the tumor (resection or ablation) or localized chemotherapy (transarterial chemoembolization), the current gold standard in the UK is sorafenib and lenvatinib, which while efficacious has important adverse effects. Selective internal radiation therapy (SIRT) provides an alternative treatment option, that potentially avoids the serious adverse effects of systemic treatments and, for a small proportion of patients, may allow the patient to become eligible for either liver transplant or removal of the tumor. This study aimed to assess if SIRT is cost-effective, in other words, provides 'value for money' compared with sorafenib in selected patients with low tumor burden and good liver function. A cost-effectiveness model was built based on a Phase III randomized controlled trial, published studies and clinical surveys. The analyses showed that SIRT resulted in higher quality-adjusted life-years and lower or slightly higher healthcare cost depending on the selectiveness of the patient population, and thereby has the potential to be a cost-effective alternative to sorafenib.