Cost Effectiveness of Radioembolization Compared with Conventional Transarterial Chemoembolization for Treatment of Hepatocellular Carcinoma |
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| Affiliation: | 1. Department of Radiology, University of Minnesota, 420 Delaware Street SE, Minneapolis, MN 55455;2. Department of Medicine, Cardiology Division, University of Minnesota, 420 Delaware Street SE, Minneapolis, MN 55455;3. Department of Radiology, MD Anderson Cancer Center, University of Texas, Houston, Texas;1. Department of Diagnostic and Interventional Radiology, Shanghai Jiao Tong University Affiliated Sixth People’s Hospital, No. 600 Yi Shan Road, Shanghai 200233, China.;2. Department of Diagnostic and Interventional Radiology, The Chinese People’s Liberation Army Affiliated The 85th Hospital, Shanghai 200233, China.;1. Department of Radiology and Nuclear Medicine, VU University Medical Center, De Boelelaan 1117, 1081HV Amsterdam, the Netherlands;2. Department of Surgical Oncology, VU University Medical Center, De Boelelaan 1117, 1081HV Amsterdam, the Netherlands;1. Division of Gastroenterology, Department of Medicine, University of California, San Francisco, California;2. Center for Organ and Cell Transplantation, Scripps Green Hospital, La Jolla, California;3. Department of Surgery, Icahn School of Medicine at Mount Sinai, New York, New York;4. Division of Gastroenterology and Hepatology, University of Pennsylvania, Philadelphia, Pennsylvania;5. Department of Transplantation, California Pacific Medical Center, San Francisco, California;6. Division of Gastroenterology and Hepatology, University of Michigan, Ann Arbor, Michigan;7. Division of Gastroenterology and Hepatology, Stanford University, Palo Alto, California;8. Division of Transplant Surgery, Department of Surgery, University of California, San Francisco, San Francisco, California |
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| Abstract: | PurposeTo assess cost effectiveness of radioembolization versus conventional transarterial chemoembolization.Materials and MethodsThe cost of radioembolization versus conventional transarterial chemoembolization was determined based on Medicare reimbursements. Three patient subgroups were defined based on the Barcelona Clinic Liver Cancer (BCLC) classification system (A, B, or C). Efficacy and safety outcomes after each procedure were obtained from the literature. A Monte Carlo case-based simulation was designed for 60 months in 250 patients in each subgroup. Survival was calculated based on average survival from the literature and the Monte Carlo model. The primary outcome was the cost effectiveness of radioembolization over transarterial chemoembolization by considering calculated survival.ResultsThe costs approached $17,000 for transarterial chemoembolization versus $31,000 or $48,000 for unilobar or bilobar radioembolization, respectively. Based on the simulation, median estimated survival was greater with transarterial chemoembolization than radioembolization in BCLC-A and BCLC-B subgroups (40 months vs 30 months and 23 months vs 16 months, respectively, P = .001). However, in the BCLC-C subgroup, survival was greater with radioembolization than transarterial chemoembolization (13 months vs 17 months, P = .001). The incremental cost-effectiveness ratio of radioembolization over transarterial chemoembolization in the BCLC-C subgroup was $360 per month. The results were dependent on bilobar versus unilobar radioembolization and the total number of radioembolization procedures.ConclusionsThe model suggests radioembolization costs may be justified for patients with BCLC-C disease, whereas radioembolization may not be cost effective in patients with BCLC-A disease; however, many patients with BCLC-C disease have extensive disease precluding locoregional therapies. Secondary considerations may determine treatment choice in more borderline patients (BCLC-B disease) because there is no persistent survival benefit with radioembolization. |
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| Keywords: | BCLC" },{" #name" :" keyword" ," $" :{" id" :" key0010" }," $$" :[{" #name" :" text" ," _" :" Barcelona Clinic Liver Cancer HCC" },{" #name" :" keyword" ," $" :{" id" :" key0020" }," $$" :[{" #name" :" text" ," _" :" hepatocellular carcinoma yttrium-90 |
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