Objectives: To assess the cost-effectiveness of selective internal radiation therapy (SIRT) compared with sorafenib for the treatment of patients with advanced hepatocellular carcinoma in the United Kingdom, including a selected subgroup of patients who have been identified as benefiting from treatment with SIRT. Methods: A de novo economic model was developed comparing SIRT with sorafenib using data from two large randomized controlled trials. The model structure comprised a decision tree representing the outcome of the work-up procedure, transitioning into a 3-state partitioned survival model to project long-term survival outcomes. Cost-effectiveness in a post hoc defined subgroup with low tumor burden and good liver function was explored. Results: At list price, SIRT was predicted to be less costly but less effective than sorafenib with an estimated saving of £156 089 per quality-adjusted life-year forgone, with cost savings of £4589 and 0.029 fewer quality-adjusted life-years than sorafenib. Accounting for existing confidential discounts for sorafenib, two SIRTs were cost-effective at a £30 000 willingness-to-pay threshold compared with sorafenib when a discount for the technologies was introduced. In the subgroup with low tumor burden and good liver function, SIRT may be associated with greater survival benefits and cost savings. Conclusions: Accounting for confidential discounts, on average, SIRT technologies represent value for money in the whole advanced hepatocellular carcinoma population, being less effective but less costly than sorafenib. Results from a subgroup with low tumor burden and good liver function suggest that the cost-effectiveness of SIRTs may be maximized in this group, but further research is required to demonstrate the validity of effectiveness benefits.
Bibliographical noteFunding Information:
Conflict of Interest Disclosures: All authors reported that the project was funded by the National Institute for Health Research Technology Assessment Reviews program (award identification 17/109/19). No other disclosures were reported.
Funding/Support: This manuscript is based on work commissioned by the National Institute for Health Research Health Technology Associate Program, project number 17/109/19.
The authors thank Dr Daniel Swinson, Consultant Clinical Oncologist, Leeds Teaching Hospitals NHS Trust; Dr Jai Patel, Consultant Vascular and Interventional Radiologist, Leeds Teaching Hospitals NHS Trust; and Ian Rowe, University of Leeds Academic Fellow and Honorary Consultant Hepatologist, Leeds Teaching Hospitals NHS Trust for advice throughout the project. The authors thank BTG, Terumo Europe, and Sirtex Medical for responding to requests for additional data.
© 2021 ISPOR–The Professional Society for Health Economics and Outcomes Research
- hepatocellular carcinoma