Cost-effectiveness of hepatic arterial chemoembolization for colorectal liver metastases refractory to systemic chemotherapy.
OBJECTIVE
To calculate the cost-effectiveness of hepatic arterial chemoembolization (HACE) for the treatment of colorectal liver metastases (CLM) over a range of survival benefits and to determine the survival benefit that HACE must confer to meet three thresholds of cost-effectiveness.


METHODS
A spreadsheet model was used to estimate the marginal direct cost of HACE compared with palliative care from a payer's perspective. Medicare reimbursement amounts represented costs, while probabilities of reembolization and complications were obtained from records of patients who underwent HACE. Marginal cost-effectiveness was calculated from marginal direct cost by varying the survival benefit of HACE compared with palliative care from 0 to 24 months. Break-even analyses were conducted to determine the survival benefit at which the cost-effectiveness of HACE would decrease below three threshold values derived from a literature review.


RESULTS
The marginal cost-effectiveness of HACE compared with palliative care, given survival benefits of 3, 6, and 12 months, was $82,385, $41,193, and $21,045 per life-year (LY) gained, respectively. Cost-effectiveness thresholds of $20,000 (strict), $50,000 (moderate), and $100,000 (generous) per LY gained required survival benefits of 12.63, 4.94, and 2.47 months, respectively, more than the expected baseline.


CONCLUSIONS
The cost-effectiveness of HACE for the treatment of CLM varies considerably according to the anticipated survival benefit. Results of future randomized controlled trials must demonstrate a survival benefit of nearly 5 months for HACE to meet the moderate cost-effectiveness standard of $50,000 per LY gained.
Abramson
R G
RG
Harvard Medical School, Boston, Department of Radiology, Beth Israel Deaconess Medical Center, 330 Brookline Ave, Boston, MA 02215, USA.
Rosen
M P
MP
Perry
L J
LJ
Brophy
D P
DP
Raeburn
S L
SL
Stuart
K E
KE
D000903:Antibiotics, Antineoplastic / Q000008:administration & dosage; D000964:Antimetabolites, Antineoplastic / Q000008:administration & dosage; D000970:Antineoplastic Agents / Q000627:therapeutic use*; D019985:Benchmarking; D016461:Chemoembolization, Therapeutic / Q000009:adverse effects / Q000191:economics*; D003110:Colonic Neoplasms / Q000473:pathology*; D003362:Cost-Benefit Analysis; D004180:Direct Service Costs; D005472:Fluorouracil / Q000008:administration & dosage; D005500:Follow-Up Studies; D005781:Gelatin Sponge, Absorbable / Q000008:administration & dosage; D017048:Health Care Costs; D006499:Hepatic Artery; D006801:Humans; D008113:Liver Neoplasms / Q000188:drug therapy / Q000556:secondary* / Q000628:therapy; D006278:Medicare / Q000191:economics; D016685:Mitomycin / Q000008:administration & dosage; D010166:Palliative Care / Q000191:economics; D011336:Probability; D016032:Randomized Controlled Trials as Topic; D012004:Rectal Neoplasms / Q000473:pathology*; D019233:Retreatment; D012189:Retrospective Studies; D016019:Survival Analysis; D017211:Treatment Failure; D014481:United States; D026712:Value of Life
D000903:Antibiotics, Antineoplastic; D000964:Antimetabolites, Antineoplastic; D000970:Antineoplastic Agents; D016685:Mitomycin; D005472:Fluorouracil