OBJECTIVES:

Selective internal radiation therapy (SIRT) has a proven safety and efficacy record in patients with hepatocellular carcinoma (HCC) in Barcelona Clinic Liver Cancer Stage (BCLC) stage C, with the SARAH randomized controlled trial (RCT) showing significantly higher complete and partial response rates with SIRT versus sorafenib, and significantly better quality of life. The aim of the present study was to evaluate the budget impact of SIRT versus atezolizumab-bevacizumab in the treatment of patients with BCLC C HCC in England.

METHODS:

A budget impact analysis was conducted from the perspective of the Department of Health and Social Care (DHSC). Costs of SIRT using Y-90 resin microspheres were calculated using procedure unit costs from the National Tariff 2022/23 and the published manufacturer list price of SIR-Spheres Y-90 resin microspheres. Costs of atezolizumab-bevacizumab were obtained from the British National Formulary (BNF), with administration costs based on the National Tariff. Comparable adverse event (AE) incidence data were not available from the SARAH and IMbrave150 RCTs and AE costs were therefore excluded. Analyses were run for “same-stay” SIRT (using the Order-Map-Treat Program) and SIRT with separate hospital spells for work-up and procedure. Costs of subsequent systemic treatments were captured based on expert opinion and costed based on the BNF.

RESULTS:

Over a three-year time horizon, “same-stay” SIRT resulted in cost savings of GBP 27,511 per patient versus atezolizumab-bevacizumab (GBP 32,255 versus GBP 59,766), while SIRT in which the work-up was performed during a separate hospital spell was GBP 25,167 less expensive than atezolizumab-bevacizumab per patient. The analysis was most sensitive to list price discounts associated with atezolizumab and bevacizumab, and time-on-treatment assumptions.

CONCLUSIONS:

SIRT using Y-90 resin microspheres was found to be cost saving versus atezolizumab-bevacizumab from the perspective of the DHSC in patients with BCLC stage C HCC.