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Table 3 Results of full economic evaluations for hepatocellular carcinoma

From: Economic evaluations of radioembolization with Itrium-90 microspheres in hepatocellular carcinoma: a systematic review

Author, year publication (year cost)

Stage

Comparators

Costs

Outcome’s health

Ratio cost/outcome’s health

Original cost

Adjusted to $US PPP [18]

LYG

QALY

ICER

€/LYG

ICUR

€/QALY

ICER

$US PPP/LYG

ICUR

$US PPP/QALY

TARE versus TACE

Rostambeigi, 2014 [20] (2013)a

  

Monthlyb

 

OS months

     

BCLC-A

TACE

$ 2094

2347

39.5

ND

TACE versus

ND

TACE versus

ND

 

TARE (I)

$ 1770

1311

29.7

ND

$33/LMG

ND

37/ LMG

ND

  

Δ − $ 324

Δ − 363

Δ 9.8

 

[$ 396 LYG]*

 

[444/LYG]*

 
 

TARE (II)

$ 2688

3013

29.7

ND

$61/LMG

ND

68/LMG

ND

  

Δ $ 594

Δ 666

Δ 9.8

 

[− $ 732 LYG]*

 

[− 820/LYG]*

 

BCLC-B

TACE

$ 2326

2607

22.9

ND

TACE versus

 

TACE versus

 
 

TARE (I)

$ 2789

3126

16.0

ND

$67/LMG

ND

75/LMG

ND

  

Δ $ 463

519

Δ 6.9

 

[− $ 804 LYG]*

 

[− 901/LYG]*

 
 

TARE (II)

$ 4240

4753

16.0

ND

$277/LMG

ND

310/LMG

ND

  

Δ $1914

2145

Δ 6.9

 

[− $3324 LYG]*

 

[− 3726/LYG]*

 

BCLC-C

TACE

$ 2679

3003

13.3

ND

TACE versus

 

TACE versus

 
 

TARE (I)

$2652

2973

17.1

ND

$7/LMG

ND

8/LMG

ND

  

Δ − $27

Δ − 30

Δ 3.8

 

[Dominant]*

 

[Dominant]*

 
 

TARE (II)

$4031

4518

17.1

ND

$356/LMG

ND

399/LMG

ND

  

Δ $1352

Δ 1515

Δ 3.8

 

[$ 4272 LYG]*

 

[− 4788/LYG]*

 

Rostambeigi, 2014 [21] (2013)a

    

OS months

     

BCLC-A, BCLC-B, and BCLC-C

TACE

$ 17,000

19,055

BCLC-A: 37

BCLC-B: 22

BCLC-C: 12

ND

ND

ND

ND

ND

TARE

$ 49,000

54,924

BCLC-A: 32

BCLC-B: 18

BCLC-C: 19

ND

ND

ND

ND

ND

BCLC-C

TARE-TACE

Δ $ 500

Δ 560

 

ND

ND

ND

ND

ND

Manas, 2021 [22]c (2020)

BCLC-A, BCLC-B

TARE (T™)

£ 49,583

49,921

3.05

2.24

TARE versus

TARE versus

TARE versus

TARE versus

TACE

£ 37,038

37,291

2.14

1.57

£ 12,808

£ 17,279

12,291

17,397

DEB-TACE

£ 33,206

33,432

2.14

1.57

£ 17,059

£ 23,020

17,175

23,177

TAE

£ 37,015

37,267

2.14

1.57

£ 12,833

£ 17,300

12,921

17,418

    

Δ 0.91

Δ 0.67

WTP (£20.000/QALY): 15.9% (TARE vs. DEB-TACE) to 76.8% (TARE vs. TACE) WTP (£30.000/QALY): 88.6% (TARE vs. DEB-TACE) to 98.7% (TARE vs. TAE)

Rognoni, 2018 [23] (2016)

BCLC-B

TTS (47% sorafenib)

€ 36,509

37,137

3.494

1.385

TTS Dominant

  
 

TS

€ 42,812

43,591

2.361

0.937

    
  

Δ − € 6303

Δ − 6418

Δ − 1.133

Δ 0.448

TTS WTP (€50,000/QALY): 83%

TARE versus TKI

Chaplin, 2015 [24] (2015)a

BCLC-C

TARE (T™)

£ 21,441

22,763

ND

1.12

ND

TARE Dominant

ND

TARE Dominant

 

Sorafenib

£ 34,050

36,150

ND

0.85

ND

   
  

Δ − £ 12,609

Δ − 13,387

ND

Δ 0.27

ND

   
    

TARE versus sorafenib

TTP (months): 6.2 versus 4.9

OS (months): 13.8 versus 9.7

    

Palmer, 2017 [25] (2017)

BCLC-C

TARE (S®)

£ 8909 in favour of TARE

9374 favour of TARE

ND

Δ 0.0079 in favour of TARE

ND

TARE cost-effective

ND

TARE cost-effective

 

Sorafenib

      
  

Cost drivers: workup and administrations for TARE and duration of treatment for sorafenib

      

Rognoni, 2017 [26] (2015)

BCLC-B

TARE

€ 31,071

31,644

2.531

1.178

TARE versus

TARE versus

TARE versus

TARE versus

 

Sorafenib

€ 29,289

29,829

1.575

0.638

1865

3302

1899

3363

  

Δ € 1782

Δ 1815

Δ 0.956

Δ 0.540

WTP (€38500/QALY): 99.2%

  

BCLC-C

TARE

€ 21,961

22,366

1.445

0.639

ND

TARE Dominant

ND

TARE Dominant

 

Sorafenib

€ 30,750

31,317

1.306

0.568

    
  

Δ − € 8788

Δ − 8950

Δ 0.139

Δ 0.071

WTP (€38.500/QALY): 98.2%

  

Parikh, 2018 [27] (2018)a

BCLC-C

Pooled data

     

Sorafenib versus

 

Sorafenib versus

 

TARE

$ 61,897

65,295

ND

0.81

ND

$ 19,534

ND

20,606

 

Sorafenib

$ 63,313

66,789

ND

0.88

    
  

Δ − $ 1416

Δ − 1494

ND

Δ − 0.07

    
 

CT SARAH

     

Sorafenib versus

 

Sorafenib versus

 

TARE

$ 64,805

68,363

ND

0.78

 

TARE versus

 

TARE versus

 

Sorafenib

$ 63,216

66,687

ND

0.87

ND

Sorafenib Dominant

ND

Sorafenib Dominant

  

Δ $ 1589

Δ 1676

ND

Δ − 0.09

    
 

CT SIRveNIB

     

Sorafenib versus

 

Sorafenib versus

 

TARE

$ 57,473

60,628

ND

0.84

ND

$ 107,927

ND

113,852

 

Sorafenib

$ 63,447

66,930

ND

0.90

    
  

Δ − $ 5974

Δ − 6302

ND

Δ − 0.06

    

Walton, 2020 [28] (2017/2018)

BCLC-B and BCLC-C

Deterministic

        
 

TARE (T™)

£ 29,888

30,922

1.110

0.764

NMB (£)

TARE (T™) versus

NMB (£)

TARE (T™) versus

 

TARE (S®)

£ 30,107

31,148

1.110

0.764

218

+ Costly

226

+ Costly

 

TARE (Q®)

£ 36,503

37,766

1.110

0.764

6614

+ Costly

6843

+ Costly

 

Lenvatinib

£ 30,005

31,043

1.243

0.841

97

28,728

100

29,722

 

Sorafenib

£ 32,082

33,192

1.183

0.805

1090

2911

1128

3012

 

Probabilistic

        
 

TARE (T™)

£ 30,014

31,052

1.111

0.765

NMB (£)

TARE (T™) versus

NMB (£)

TARE (T™) versus

 

TARE (S®)

£ 30,196

31,240

1.111

0.765

2154

Dominated

 2229

Dominated

 

TARE (Q®)

£ 36,613

37,879

1.111

0.765

2323

Dominated

 2403

Dominated

 

Lenvatinib

£ 29,658

30,684

1.244

0.841

2306

174,320

 2386

180,349

 

Sorafenib

£ 32,444

33,566

1.202

0.825

8741

Dominated

 9043

Dominated

Muszbek, 2020–21 [29]d (2018/2019)

BCLC-B and BCLC-C

TARE (S®)

£ 29,530

30,085

2.637

1.982

 

TARE Dominant

 

TARE Dominant

 

Sorafenib

£ 30,957

31,539

1.890

1.381

ND

 £ 2374

ND

−2719

  

Δ − £ 1427

Δ − 1454

Δ 0.748

Δ 0.601

TARE (S®) WTP (£ 20,000): 95%. INB (£) at threshold of £20,000: £ 13,443

  

Marqueen, 2021 [30] (2016/2017)

BCLC-C

Pooled data

        
 

Sorafenib

$ 78,859

84,868

 

0.88

 

Sorafenib versus

 

Sorafenib versus

 

TARE

$ 58,397

62,847

 

0.87

ND

$ 1,280,224

ND

1,377,777

  

Δ $20,462

Δ 22,061

 

Δ 0.02

Sorafenib WTP ($200,000/QALY): 1%

  
 

CT SARAH

        
 

Sorafenib

$ 72,899

78,454

 

0.83

 

Sorafenib versus

 

Sorafenib versus

 

TARE

$ 66,800

71,890

 

0.84

ND

TARE dominant

ND

TARE dominant

  

Δ $ 6099

Δ 6564

 

Δ − 0.01

    
 

CT SIRveNIB

        
 

Sorafenib

$ 89,806

96,649

 

0.91

 

Sorafenib versus

 

Sorafenib versus

 

TARE

$ 46,151

49,668

 

0.86

ND

$ 753,412

ND

810,822

  

Δ $43,655

Δ 46,982

 

Δ 0.06

    
  1. BC base case, BCLC Barcelona Clinic Liver Cancer classification, CT clinical trial, DEB-TACE doxorubicin eluting bead transarterial chemoembolization, HCC hepatocellular carcinoma, CI confidence interval, ICER cost-effectiveness incremental ratio, ICUR incremental cost-utility ratio, INB incremental net benefit, LYG life years gained, LMG life moth gained, ND no data, NMB net monetary benefit, OS overall survival, QALY quality-adjusted life years, TACE transarterial chemoembolization, TAE transarterial embolization, TARE transarterial radioembolization, TARE (I) unilobar, TARE (II) bilobar, TARE (S®) transarterial radioembolization with SIR-Spheres®, TARE (T™) transarterial radioembolization with TheraSphere™, TARE (Q®) transarterial radioembolization with QuiremSpheres®, TKI tyrosine kinase inhibitors, TTP time to progression, TTS sequency TARE, TACE and optional sorafenib (sorafenib was administered on 47% of patients), WTP willingness-to-pay
  2. *Determined by calculations assuming a year has 12 months
  3. aYear of unspecified cost, estimated from the proposed cost reference sources
  4. bThe procedure is repeated every 10 months until 5 years
  5. cNumber of patients downstaged (out of 1000 patients): 842 TheraSphere™ and 452 TACE, DEB-TACE and TAE
  6. dTARE allows downstaging for subsequent treatment with curative intent: 13.5% TARE versus 2.1% sorafenib (base case considering SARAH study data), and 5.1 TARE versus 1.4% sorafenib in the ITT population