OBJECTIVES: The aim of the study was to perform a cost-effectiveness analysis comparing personalised dosimetry with standard dosimetry in the setting of selective internal radiation therapy (SIRT) with TheraSphere for the management of adult patients with locally advanced hepatocellular carcinoma (HCC) from the Italian Healthcare Service perspective.

METHODS: A partition survival model was developed to estimate costs and quality-adjusted life years (QALYs) over a lifetime horizon. Clinical inputs were retrieved from a published randomized controlled trial. Health resource utilization was derived through the administration of questionnaires to clinicians in three oncology centres geographically distributed in Italy that perform a high volume of SIRT procedures annually. The model considers healthcare services used in the peri-procedural period and in the follow-up. Cost parameters were based on Italian official tariffs. Deterministic and probabilistic sensitivity analyses (PSA) were performed to test the robustness of the model results.

RESULTS: Over a lifetime horizon, the model estimated average QALYs of 1.337 and 0.570 for patients undergoing personalised and standard dosimetry approaches, respectively. The estimated mean costs per patient were 23,773€ and 19,860€, respectively. The incremental cost-utility ratio of personalised vs. standard dosimetry approach was 5,048€/QALY. In the PSA nearly all the simulations (99.9%) showed the cost-effectiveness of personalised dosimetry considering a willingness-to-pay threshold of 50,000€/QALY.

CONCLUSIONS: Personalised dosimetry may be considered a cost-effective option compared to standard dosimetry for patients undergoing SIRT for HCC in Italy. These findings provide evidence for clinicians and payers on the value of personalised dosimetry as a treatment option for patients with HCC. Future studies comparing personalised approach to standard approach are recommended to increase the clinical evidence to confirm or reject the validity of this preliminary evaluation.