OBJECTIVES: Hepatocellular carcinoma (HCC) is a severe condition with poor prognosis and a significant burden. Selective internal radiation therapy (SIRT) is recommended as an alternative treatment option to overcome some limitations of current treatments. This analysis estimated the budget impact (BI) of the adoption of SIRT using Y-90 resin microspheres for the treatment of unresectable HCC in Brazil.

METHODS: The BI model was conducted from the Brazilian private payer perspective and followed the local guidelines. The studied population was intermediate- or advanced-stage HCC patients, without extrahepatic disease and ineligible to transarterial chemoembolisation; a scenario analysis included the subgroup with low tumour burden and preserved liver function. Sorafenib was the comparator in the base case analysis. A partitioned-survival model was developed, which included a tunnel state for patients downstaged to receive a treatment with a curative intent. The analysis calculated the total costs in a five-year time horizon, comparing the scenario without SIRT (all eligible patients treated with sorafenib) versus the scenario with SIRT, and assumed a gradual displacement of sorafenib with an uptake of 10% in year one and an annual increase of 5%. Population estimates were obtained from a systematic literature review. State transitions and adverse event frequencies were extracted from published sources of pivotal randomised control trials. Local costs from Brazil were applied.

RESULTS: The estimated target population was 405 patients per year. In the base case 41 patients would receive SIRT in Year 1 and 122 in Year 5, with a cumulative incremental BI of USD 1.15M. The subgroup analysis estimated 8 patients would receive SIRT in Year 1 and 23 in Year 5, with an incremental BI of USD 180,000. One-way and probabilistic sensitivity analyses confirmed robustness of the analyses.

CONCLUSIONS: The estimated BI of the adoption of SIRT using Y-90 resin microspheres is predictable and sustainable in Brazil.