Presentation (CTI)

OBJECTIVES: To assess the economic value and budget impact of reimbursing transarterial chemoembolization (TACE) for hepatocellular carcinoma (HCC) in Bulgaria.
METHODS: A health-economic model compared early/intermediate-stage TACE use, primarily BCLC B, with delayed management using systemic therapy after progression to advanced HCC. The pathway was costed over a lifetime horizon from the National Health Insurance Fund (NHIF) perspective. Cost-effectiveness, return on investment (ROI), social return on investment (SROI), and budget impact analyses were performed. Local Bulgarian inputs were used for procedure tariffs, eligible patients, procedures, NHIF expenditure, and productivity contribution.
RESULTS: Mean lifetime cost per patient was €15,211.24 with TACE versus €46,416.89 with first- and second-line systemic therapy, yielding savings of €31,205.66 per patient. TACE generated 1.94 QALYs, 0.40 more than advanced-stage systemic treatment, and was dominant. ROI was 105%, corresponding to a benefit-cost ratio of 2.05: each €1 invested saved €2.05 in NHIF treatment costs. For 28 patients annually, expected NHIF expenditure was €184,853.76. Estimated productivity gains produced an SROI of 357%, or €4.57 total return per €1 invested. Budget impact modelling showed NHIF savings of €2.895 million over 5 years and €4.109 million over 11 years.
CONCLUSIONS: Reimbursing TACE in Bulgaria is clinically and economically justified, improves patient outcomes, delays costly systemic therapy, and generates NHIF and societal savings.