title: Cost effectiveness of radioembolization compared with conventional transarterial chemoembolization for treatment of hepatocellular carcinoma.
abstract: OBJECTIVE
  To assess cost effectiveness of radioembolization versus conventional transarterial chemoembolization.
  
  
  METHODS
  The cost of radioembolization versus conventional transarterial chemoembolization was determined based on Medicare reimbursements. Three patient subgroups were defined based on the Barcelona Clinic Liver Cancer (BCLC) classification system (A, B, or C). Efficacy and safety outcomes after each procedure were obtained from the literature. A Monte Carlo case-based simulation was designed for 60 months in 250 patients in each subgroup. Survival was calculated based on average survival from the literature and the Monte Carlo model. The primary outcome was the cost effectiveness of radioembolization over transarterial chemoembolization by considering calculated survival.
  
  
  RESULTS
  The costs approached $17,000 for transarterial chemoembolization versus $31,000 or $48,000 for unilobar or bilobar radioembolization, respectively. Based on the simulation, median estimated survival was greater with transarterial chemoembolization than radioembolization in BCLC-A and BCLC-B subgroups (40 months vs 30 months and 23 months vs 16 months, respectively, P = .001). However, in the BCLC-C subgroup, survival was greater with radioembolization than transarterial chemoembolization (13 months vs 17 months, P = .001). The incremental cost-effectiveness ratio of radioembolization over transarterial chemoembolization in the BCLC-C subgroup was $360 per month. The results were dependent on bilobar versus unilobar radioembolization and the total number of radioembolization procedures.
  
  
  CONCLUSIONS
  The model suggests radioembolization costs may be justified for patients with BCLC-C disease, whereas radioembolization may not be cost effective in patients with BCLC-A disease; however, many patients with BCLC-C disease have extensive disease precluding locoregional therapies. Secondary considerations may determine treatment choice in more borderline patients (BCLC-B disease) because there is no persistent survival benefit with radioembolization.
authors.affiliation: Department of Radiology, University of Minnesota, 420 Delaware Street SE, Minneapolis, MN 55455. Electronic address: rostam@umn.edu.
authors.forename: Nassir
authors.initials: N
authors.lastname: Rostambeigi
authors.affiliation: Department of Radiology, University of Minnesota, 420 Delaware Street SE, Minneapolis, MN 55455.
authors.forename: Adrienne S
authors.initials: AS
authors.lastname: Dekarske
authors.affiliation: Department of Medicine, Cardiology Division, University of Minnesota, 420 Delaware Street SE, Minneapolis, MN 55455.
authors.forename: Erin E
authors.initials: EE
authors.lastname: Austin
authors.affiliation: Department of Radiology, University of Minnesota, 420 Delaware Street SE, Minneapolis, MN 55455.
authors.forename: Jafar
authors.initials: J
authors.lastname: Golzarian
authors.affiliation: Department of Radiology, MD Anderson Cancer Center, University of Texas, Houston, Texas.
authors.forename: Erik N
authors.initials: EN
authors.lastname: Cressman
mesh_terms: D000970:Antineoplastic Agents / Q000009:adverse effects / Q000191:economics* / Q000627:therapeutic use*; D006528:Carcinoma, Hepatocellular / Q000191:economics* / Q000401:mortality / Q000532:radiotherapy / Q000628:therapy*; D016461:Chemoembolization, Therapeutic / Q000009:adverse effects / Q000191:economics* / Q000379:methods / Q000401:mortality; D003198:Computer Simulation; D003362:Cost-Benefit Analysis; D016527:Drug Costs; D004621:Embolization, Therapeutic / Q000009:adverse effects / Q000191:economics* / Q000379:methods / Q000401:mortality; D006801:Humans; D007349:Insurance, Health, Reimbursement; D008113:Liver Neoplasms / Q000191:economics* / Q000401:mortality / Q000532:radiotherapy / Q000628:therapy*; D006278:Medicare; D018803:Models, Economic; D009010:Monte Carlo Method; D018579:Patient Selection; D019275:Radiopharmaceuticals / Q000009:adverse effects / Q000191:economics* / Q000627:therapeutic use*; D013997:Time Factors; D016896:Treatment Outcome; D014481:United States
chemical_list: D000970:Antineoplastic Agents; D019275:Radiopharmaceuticals