Cost-effectiveness of doxorubicin-eluting beads versus conventional trans-arterial chemo-embolization for hepatocellular carcinoma.
BACKGROUND
Doxorubicin-loaded drug-eluting beads TACE (DEB-TACE) has been developed to maximize the therapeutic efficacy of conventional trans-catheter arterial chemo-embolization (cTACE) in patients with hepatocellular carcinoma (HCC); however, its cost-effectiveness (CE) still needs to be assessed.


OBJECTIVE
To investigate the CE of DEB-TACE versus cTACE.


METHODS
Results from a meta-analysis of the pertinent literature were used to construct a CE Markov simulation model which followed a hypothetical cohort of HCC patients who underwent DEB-TACE or cTACE, covering the entire post-TACE lifespan until death. Costs were assessed from the health-care provider perspective.


RESULTS
Five randomized controlled trials (RCTs) and 11 observational studies, including 1860 patients (883 DEB-TACE and 977 cTACE), were used for the construction of the model. Considering only survival rates from RCTs (heterogeneity: 0%), DEB-TACE returned 4.0 quality-adjusted life-years (QALYs) and TACE returned 3.3 QALYs (effect size=1.288). Total costs of cTACE were €10,389 and those of DEB-TACE were €11,418 (effect size=0.791). DEB-TACE was found more cost-effective than cTACE when a minimum willingness-to-pay of about €2000-3500/QALY was accepted, mainly depending on shorter in-hospital stay and better quality of life.


CONCLUSIONS
Direct incremental costs of DEB-TACE can be acceptable in respect to cTACE, relying on financial resources available from the payer perspective.
Department of Medical and Surgical Sciences - DIMEC, Alma Mater Studiorum - University of Bologna, S. Orsola-Malpighi Hospital, Bologna, Italy.
Alessandro
A
Cucchetti
Department of Medical and Surgical Sciences - DIMEC, Alma Mater Studiorum - University of Bologna, S. Orsola-Malpighi Hospital, Bologna, Italy.
Franco
F
Trevisani
Radiology Unit, Department of Digestive Disease and Internal Medicine, S. Orsola-Malpighi Hospital, Bologna, Italy. Electronic address: alberta.cappelli@aosp.bo.it.
Alberta
A
Cappelli
Radiology Unit, Department of Digestive Disease and Internal Medicine, S. Orsola-Malpighi Hospital, Bologna, Italy.
Cristina
C
Mosconi
Radiology Unit, Department of Digestive Disease and Internal Medicine, S. Orsola-Malpighi Hospital, Bologna, Italy.
Matteo
M
Renzulli
Department of Medical and Surgical Sciences - DIMEC, Alma Mater Studiorum - University of Bologna, S. Orsola-Malpighi Hospital, Bologna, Italy.
Antonio Daniele
AD
Pinna
Radiology Unit, Department of Digestive Disease and Internal Medicine, S. Orsola-Malpighi Hospital, Bologna, Italy.
Rita
R
Golfieri
D000903:Antibiotics, Antineoplastic / Q000627:therapeutic use*; D006528:Carcinoma, Hepatocellular / Q000473:pathology / Q000628:therapy*; D016461:Chemoembolization, Therapeutic / Q000191:economics*; D003362:Cost-Benefit Analysis; D004317:Doxorubicin / Q000627:therapeutic use*; D006801:Humans; D008113:Liver Neoplasms / Q000473:pathology / Q000628:therapy*; D008863:Microspheres; D011788:Quality of Life; D016032:Randomized Controlled Trials as Topic
D000903:Antibiotics, Antineoplastic; D004317:Doxorubicin
Liver cancer; Markov model; Meta-analysis; Quality of life; Survival