Table 5 Results of partial economic evaluations for hepatocellular carcinoma
Author, year publication (year cost) | Stage | Comparators | Costs | Resource consumption and health outcomes | |||||||
|---|---|---|---|---|---|---|---|---|---|---|---|
Original cost | Adjusted to $US PPP [18] | ||||||||||
TARE versus TACE versus ablative therapy | |||||||||||
Ray, 2012 [34] (2010) | BCLC-Aa | Decision tree | Monte Carlo | Decision tree | Monte Carlo | Threshold of repetitions to considered TARE an optimal strategy: – TARE repetition rate: 1–10% – TACE repetition rate: 82–77% TARE would be an optimal strategy versus TACE in 33.4 to 36.4% of cases | |||||
TARE | $ 35,618 | $ 35,629 ± 9930 | 42,368 | 42,381 ± 11,812 | |||||||
TACE | $ 30,143 | $ 30,107 ± 19,109 | 35,855 | 35,812 ± 22,730 | |||||||
RFA | $ 9361 | $ 9362 ± 2555 | 11,135 | 11,136 ± 3309 | |||||||
Ljuboja, 2021[35] (2020)b | ND | Total cost/patient | Personal | Equipment | Consumables | Total cost/patient | Personal | Equipment | Consumables | Consumables reported for the highest cost in all three procedures, with a single consumable accounting for more than 30% of the total cost of each procedure | |
TARE | $20,818 (100%) | $ 1656 (8%) | $ 371 (2%) | $ 18,791 (90%) | 21,074 | 1676 | 376 | 19,022 | |||
TACE | $ 5089 (100%) | $ 1947 (38%) | $ 212 (4%) | $ 2930 (58%) | 5152 | 1971 | 215 | 2966 | |||
Ablation | $ 3744 (100%) | $ 1114 (30%) | $ 205 (5%) | $ 2425 (65%) | 3790 | 3837 | 208 | 2455 | |||
TARE versus TACE and/or TKI | |||||||||||
Colombo, 2015 [31] (2014) | BCLC-B BCLC-C | Annual cost/patient | Monthly cost/patient | Annual cost/patient | Monthly cost/patient | Average number of treatments per year: | |||||
TARE | 26,106 € | 17,404 € | 26,629 | 17,753 | TARE 1.50 | ||||||
TACE | 13,418 € | 5304 € | 13,687 | 5410 | TACE 2.53 | ||||||
Sorafenib | 12,215 € | 2009 € | 12,460 | 2,049 | Sorafenib 6.08 | ||||||
Muszbek, 2019 [33] (2018/2019) | BCLC-Bb | Annual cost/patient | Annual cost/patient | The main cost driver is the number of TARE procedures per patient: TARE (glass): 1.08–1.20 TARE (resin): 1.20–1.58 | |||||||
TARE (T™) | £ 12,026–£ 21,425 | 12,442–22,166 | |||||||||
TARE (S®) | £ 11,185–£ 15,636 | 11,572–16,177 | |||||||||
TACE | £ 9257–£ 14,167 | 9577–14,657 | |||||||||
Hubert, 2016 [32] (2016)b | BCLC-B BCLC-C | TARE, TACE and sorafenib | BIA HCC patients (n = 200 annual)c. TARE saved: | BIA HCC patients (n = 200 annual). TARE saved: | Costs at 3rd year (n = 200 patients) were device acquisition ($ 207,000 [227,526 $US PPP]); administration cost savings of $ 281,000 (308,864 $US PPP) and AE management savings of $ 1000 (1099 $US PPP) | ||||||
Year 1: $ 37,000 | Year 1: 40,699 | ||||||||||
Year 2: $ 55,000 | Year 2: 64,454 | ||||||||||
Year 3: $ 75,000 | Year 3: 82,437 | ||||||||||
TARE was associated with cost savings and reduced use of hospital resources | |||||||||||
TARE versus TKI | |||||||||||
Lucà, 2017 [36] (2017)b | BCLC-B BCLC-C | Total cost per patient | Total cost per patient | At 2 years, the survival rate of TARE versus sorafenib SOR3 was significantly higher (p = 0.012). There was no significant difference in OS in the Kaplan–Meier analysis of SOR3 and TARE (p = 0.446) | |||||||
TARE | € 17,761 | 18,096 | |||||||||
Sorafenib (SOR3) | € 27,992 | 28,520 | |||||||||
TARE cost was significantly lower than sorafenib (p = 0.028). Limitations: small number of patients (n = 24) and the lack of randomisation in treatment type assignment | |||||||||||
Muszbek, 2019 [38] (2018/2019) | BCLC-Cd | Health status cost per month | Health status cost per month | Costs 2007/2015 versus costs 2018/2019: Monthly cost is lower in the pre-progression and post-progression states (by 55% and 80%, respectively), due to reduced hospitalizations and social care | |||||||
Pre | Progression | Post | Pre | Progression | Post | ||||||
TARE | £ 246 | £208 | £499 | 251 | 212 | 508 | |||||
TKI | £ 287 | £208 | £287 | 292 | 212 | 292 | |||||
Cost drivers in pre- and post-progression 2018/2019: diagnostic procedures (53%) and medical consultations (45%) 2007/2015: hospitalisations (41%) and social care (42%) | |||||||||||
Rognoni, 2018 [37] (2018) | 5 years | Lifetime | 5 years | Lifetime | Considering TARE/sorafenib utilisation rates of 30%/70% (year 1), 40%/60% (year 3) and 50%/50% (year 5–10), it was estimated: – Nº. deaths avoided: 2 in 5 years and 14 in 10 years – Nº of hospitalizations avoided due to hepatic decompensation: 32 in 5 years | ||||||
BCLC-B | TARE | € 33,040 | € 28,003 | 33,393 | 28,302 | ||||||
Sorafenib | € 29,935 | € 29,716 | 30,255 | 30,034 | |||||||
BCLC-C | TARE | € 22,526 | € 21,456 | 22,767 | 21,685 | ||||||
Sorafenib | € 31,526 | € 31,430 | 31,863 | 31,766 | |||||||
BCLC-B, BCLC-C | BIA considering increased use of TARE (stage BCLC-B and C): | BIA considering increased use of TARE: | |||||||||
Year 0 (TARE 20%, SOR 80%): | € 30,139,457 | Year 0 | 30,461,565 | ||||||||
Year 1 (TARE 30%, SOR 70%): | € 29,633,336 | Year 1 | 29,950,035 | ||||||||
Year 2 (TARE 30%, SOR 70%): | € 29,239,463 | Year 2 | 29,551,953 | ||||||||
Year 3 (TARE 40%, SOR 60%): | € 28,685,595 | Year 3 | 28,992,165 | ||||||||
Year 4 (TARE 40%, SOR 60%): | € 28,311,921 | Year 4 | 28,614,498 | ||||||||
Year 5 (TARE 50%, SOR 50%): | € 27,793,820 | Year 5 | 28,090,860 | ||||||||
Pollock, 2020 [39] (2018) | BCLC-B, BCLC-C | BIA at 3 years | France (n = 699) | Italy (n = 629) | Spain (n = 497) | UK (n = 465) | France (n = 699) | Italy (n = 629) | Spain (n = 497) | UK (n = 465) | The highest resource consumption was: – Scenario without TARE: pharmacological cost – Scenario with TARE: pharmacological cost, work-up and procedure cost with TARE In Spain, higher total costs mainly derived from the management of AE grade 3 and 4 Proportion of HCC patients who ultimately receive treatment with curative intent for TARE was 4.6% and for TKIs was 1.4% |
With TARE | € 23,234,726 | € 21,323,136 | € 18,905,157 | £ 15,746,274 | 23,816,048 | 21,551,022 | 21,597,385 | 16,290,893 | |||
Without TARE | € 26,314,378 | € 22,531,440 | € 25,172,537 | £ 17,054,914 | 26,972,751 | 22,772,239 | 25,496,295 | 17,644,796 | |||
Cost savings (with vs. without TARE) | 11.7% | 5.4% | 26.5% | 7.7% | |||||||