Cost of selective internal radiation therapy versus other modalities.

Abstract

Evaluation of comparative effectiveness and cost–effectiveness is an essential component in the integration of new technologies into medical management, with data from prospective clinical trials (e.g., health-related quality of life using validated tools) being mandated by most health authorities. Health economics has its own vocabulary and so a glossary of terms is provided in Table 1 for the uninitiated. One of the key issues in assessing the comparative costs and cost–effectiveness of locoregional therapies for primary and secondary cancers in the liver is the limited number prospective trials. Health economic models, however, are valuable tools for overcoming such limitations that bring together information from different sources in order to assess the expected costs and outcomes. Such information is essential for healthcare reimbursement agencies and payers at national, regional and local levels when making funding decisions in order to ensure that the allocation of limited resources is optimized. Selective internal radiation therapy versus conventional transarterial chemoembolization One of the most detailed studies comparing the cost–effectiveness of selective internal radiation therapy (SIRT) versus conventional transarterial chemoembolization (TACE) was conducted by a group from Cleveland (OH, USA) in patients with unresectable hepatocellular carcinoma (HCC) [1]. This study recorded significantly greater costs associated with conventional TACE than SIRT, largely due the greater number of mean hospital days for the initial procedure (3.5 ± 0.7 vs 0.5 ± 0.2; p < 0.001) and for readmissions (7.9 ± 1.7 vs 3.6 ± 0.6; p = 0.03) with TACE. While the rates of postembolization syndrome were similar between the procedures in this study, the severity of postembolization syndrome was significantly worse with TACE, as would be expected from a purely embolic approach, and required additional hospitalization and treatment in a significantly greater number of patients compared with SIRT (p = 0 .02) [1]. Otherwise, there were no significant differences between the groups in major or minor complication rates (p = 0.58) or 30-day mortality (p = 0.07) [1]. Subsequently, a systematic review of the literature examining the comparative safety and effectiveness of SIRT and conventional TACE for the treatment of HCC concluded that the two procedures had a similar efficacy (defined by tumor response and patient survival), with significantly longer time to progression and lower toxicity with SIRT [2]. Compared with SIRT, the meta-analysis found that conventional TACE was associated with a statistically greater overall toxicity, as well as a higher rate of abdominal pain and hepatic transaminase elevation postprocedure. Numerous studies have also consistently observed a significantly shorter postprocedure hospital stay with SIRT compared with conventional TACE [2]. Although conventional TACE costs less in the majority of cases, SIRT was less expensive in 33.4% of cost analysis simulations that compared the two procedures [2].