3:00 PM Abstract No. 261 Radioembolization is cost effective in intrahepatic cholangiocarcinoma: a SEER-Medicare population study

Abstract

To analyze cost effectiveness of radioembolization in the treatment of intrahepatic cholangiocarcinoma (ICC) using the Surveillance, Epidemiology, and End Results (SEER) Medicare cancer database. Cost as measured by total treatment related reimbursement in patients diagnosed with intrahepatic cholangiocarcinoma who received chemotherapy alone or chemotherapy and Y90 radioembolization was assessed in the SEER-Medicare cancer database (1999-2012). Survival analysis was performed and incremental cost effectiveness ratios were generated. The study included 585 patients. Average age at diagnosis was 71 years (SD: 9.9), with 52% male. Twelve percent of patients received chemotherapy with radioembolization (n = 72) and 88% of patients (n = 513) received only chemotherapy. Median survival was 1043 days (95% CI: 894-1244) for chemotherapy plus radioembolization and 811 days (95% CI: 705-925) for chemotherapy alone (p = 0.02). Patients receiving combination therapy were slightly younger (71 vs 69 years, p = 0.03). There was no difference in age at treatment, sex, race, or city size between treatment groups. Multivariable analysis showed a hazard ratio for progression for combination therapy versus chemotherapy alone of 0.76 (95% CI: 0.59 - 0.97, p = 0.029). Table 1 shows cost and cost effectiveness data. The incremental cost-effectiveness ratio (ICER), a measure of cost of each added year of life, was $50,058.65 per year (quartiles: $11,454.63, $52,763.28). Combination therapy of ICC with chemotherapy and radioembolization can be a cost effective with a median cost of $50,058.65 per additional year of survival.