Real-World Data for the Evaluation of Transarterial Radioembolization versus Sorafenib in Hepatocellular Carcinoma: A Cost-Effectiveness Analysis

Rognoni, Carla; Ciani, Oriana; Sommariva, S; Tarricone, Rosanna

doi:10.1016/j.jval.2016.09.2397

Cited by 33 publications

(70 citation statements)

References 46 publications

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“…For advanced stage patients, the incremental cost-effectiveness ratio of TARE versus TACE resulted 360$ per month (3120$ per year). A more recent study performed in Italy [ 13 ] reported for intermediate stage patients an incremental cost-utility ratio (ICUR) for TARE vs. sorafenib of 3302€/QALY, whilst for advanced stage patients, TARE seemed to be a dominant strategy (lower costs and greater health improvements) compared to sorafenib.…”

Section: Introductionmentioning

confidence: 99%

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Trans-arterial radioembolization for intermediate-advanced hepatocellular carcinoma: a budget impact analysis

et al. 2018

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BackgroundTrans-arterial radio-embolization (TARE) is an emerging treatment for the management of hepatocellular carcinoma (HCC). TARE may compete with systemic chemotherapy, sorafenib, in intermediate stage patients with prior chemoembolization failure or advanced patients with tumoral macrovascular invasion with no extra-hepatic spread and good liver function.We performed a budget impact analysis (BIA) evaluating the expected changes in the expenditure for the Italian Healthcare Service within scenarios of increased utilization of TARE in place of sorafenib over the next five years.MethodsStarting from patient level data from three oncology centres in Italy, a Markov model was developed to project on a lifetime horizon survivals and costs associated to matched cohorts of intermediate-advanced HCC patients treated with TARE or sorafenib. The initial model has been integrated with epidemiological data to perform a BIA comparing the current scenario with 20 and 80% utilization rates for TARE and sorafenib, respectively, with increasing utilization rates of TARE of 30, 40 and 50% over the next 1, 3 and 5 years.ResultsCompared to the current scenario, progressively increasing utilization rates of TARE over sorafenib in the next 5 years is expected to save globally about 7 million Euros.ConclusionsRadioembolization can be considered a valuable treatment option for patients with intermediate-advanced HCC. These findings enrich the evidence about the economic sustainability of TARE in comparison to standard systemic chemotherapy within the context of a national healthcare service.Electronic supplementary materialThe online version of this article (10.1186/s12885-018-4636-7) contains supplementary material, which is available to authorized users.

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Section: Introductionmentioning

confidence: 99%

“…The cost-effectiveness model developed by Rognoni et al [ 13 ] has been applied to perform a BIA considering increasing utilization rates of TARE in place of sorafenib for the treatment of intermediate-advanced stage HCC patients in the Italian healthcare system over a 5-years horizon.…”

Section: Introductionmentioning

confidence: 99%

Trans-arterial radioembolization for intermediate-advanced hepatocellular carcinoma: a budget impact analysis

et al. 2018

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“…Patients started progression‐free status, then moved to progression disease or death (Figure ). This type of model has been used frequently to evaluate the cost‐effectiveness of therapies for advanced liver cancer . The model used a 1‐month cycle length extending over a 10‐year time horizon.…”

Section: Methodsmentioning

confidence: 99%

Cost‐effectiveness analysis of cabozantinib as second‐line therapy in advanced hepatocellular carcinoma

Liao

Huang

Hutton

et al. 2019

Liver International

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Background: In the CELESTIAL trial for patients with advanced hepatocellular carcinoma (HCC), cabozantinib showed improved survival compared with placebo but comes at a price. We aimed to investigate the cost-effectiveness of cabozantinib for sorafenib-resistant HCC from the payer's perspective of the USA, UK and China. Methods:We developed Markov models to simulate the patients pre-treated with first-line sorafenib following the CELESTIAL trial. Quality-adjusted life-years (QALYs) and incremental cost-effectiveness ratio (ICER) were calculated for the treatment with cabozantinib or best supportive care. The list price for drugs was acquired from the Red Book, the British National Formulary, West China hospital and reported literature. Adverse events, utilities weights, and transition likelihood between states were sourced from the published randomized phase III trial. A willing-to-pay threshold was set $150 000/QALY in the USA, $70 671/QALY (£50 000/QALY) in the UK and $26 481/QALY (3x GDP per capita) in China. Deterministic and probabilistic sensitivity analyses were developed to test the models' uncertainty. Results:In the base case, treatment with cabozantinib increased effectiveness by 0.13 QALYs, resulting in an ICER vs best supportive care of $833 497/QALY in the USA, $304 177/QALY in the UK and $156 437/QALY in China. The models were most sensitive to assumptions about transitions to progression with both cabozantinib and best supportive care, the utility associated with being progression free. These results were robust across a range of scenarios and sensitivity analyses, including deterministic and probabilistic analyses.Conclusions: Cabozantinib at its current cost would not be a cost-effective treatment option for patients with sorafenib-resistant HCC from the payer's perspective in the USA, UK or China. Substantial discounts are necessary to meet conventional costeffectiveness thresholds. K E Y W O R D S cabozantinib, cost-effective, hepatocellular carcinoma, incremental cost-effectiveness ratio, Markov model, second-line therapy S U PP O RTI N G I N FO R M ATI O N Additional supporting information may be found online in the Supporting Information section at the end of the article. How to cite this article: Liao W, Huang J, Hutton D, et al. Cost-effectiveness analysis of cabozantinib as second-line therapy in advanced hepatocellular carcinoma. Liver Int.

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“…The methods either consider known confounders only, or also unknown confounders through the use of instrumental variables in the multivariate regression (Prentice JC et al 2014). Examples of the use of observational data to assess the cost-effectiveness of MDs include the study by Armeni et al (2016) on MitraClip for patients with moderate/severe mitral regurgitation and by Rognoni et al (2016) on transarterial radioembolization for patients with hepatocellular carcinoma. Both of these studies used the propensity scoring method.…”

Section: Improving the Analysis Of The Available Clinical Datamentioning

confidence: 99%

Economic Evaluation of Medical Devices

Drummond¹,

Tarricone²,

Torbica³

2018

Oxford Research Encyclopedia of Economics and Finance

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There are a number of challenges in the economic evaluation of medical devices (MDs). They are typically less regulated than pharmaceuticals, and the clinical evidence requirements for market authorization are generally lower. There are also specific characteristics of MDs, such as the device–user interaction (learning curve), the incremental nature of innovation, the dynamic nature of pricing, and the broader organizational impact. Therefore, a number of initiatives need to be taken in order to facilitate the economic evaluation of MDs. First, the regulatory processes for MDs need to be strengthened and more closely aligned to the needs of economic evaluation. Second, the methods of economic evaluation need to be enhanced by improving the analysis of the available clinical data, establishing high-quality clinical registries, and better recognizing MDs’ specific characteristics. Third, the market entry and diffusion of MDs need to be better managed by understanding the key influences on MD diffusion and linking diffusion with cost-effectiveness evidence through the use of performance-based risk-sharing arrangements.

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Real-World Data for the Evaluation of Transarterial Radioembolization versus Sorafenib in Hepatocellular Carcinoma: A Cost-Effectiveness Analysis

Cited by 33 publications

References 46 publications

Trans-arterial radioembolization for intermediate-advanced hepatocellular carcinoma: a budget impact analysis

Trans-arterial radioembolization for intermediate-advanced hepatocellular carcinoma: a budget impact analysis

Cost‐effectiveness analysis of cabozantinib as second‐line therapy in advanced hepatocellular carcinoma

Economic Evaluation of Medical Devices

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