OBJECTIVES:

Selective internal radiation therapy (SIRT) is a well-tolerated treatment for hepatocellular carcinoma (HCC) that has been investigated extensively in patients with HCC in Barcelona Clinic Liver Cancer (BCLC) stage B. The present analysis aimed to evaluate the budgetary implications of using SIRT versus conventional transarterial chemoembolization (cTACE) in treating patients with BCLC B HCC in England.

METHODS:

A budget impact model was developed in Microsoft Excel to capture cost of initial treatment, adverse events (AEs), and subsequent therapy lines. Costs of SIRT using Y-90 resin microspheres and cTACE were calculated from the Department of Health and Social Care (DHSC) perspective using healthcare resource tariffs from the National Tariff 2022/23. Costs of Grade 3/4 AEs were incorporated using incidence data from the SARAH randomized controlled trial (RCT). The number of SIRT and cTACE procedures received was based on a 2015 RCT comparing the two interventions, and analyses were run both for SIRT with separate work-up and procedure hospital spells and for “same-stay” SIRT with the Order-Map-Treat Program, in which work-up and procedure occur during the same hospital spell. Subsequent systemic treatments were modeled based on expert opinion and costed based on the British National Formulary. All analyses were conducted over a three-year time horizon.

RESULTS:

Relative to cTACE, “same-stay” SIRT resulted in cost savings of GBP 2,401 per patient over 3 years (GBP 34,892 versus GBP 27,293), while SIRT in which the work-up was performed during a separate hospital spell was approximately cost neutral, saving GBP 57 versus cTACE (GBP 37,236 versus GBP 37,293). The analysis was most sensitive to the number of SIRT and TACE procedures performed per-patient and assumptions around time to progression.

CONCLUSIONS:

Same-stay SIRT using SIR-Spheres Y-90 resin microspheres was found to be cost saving versus cTACE from the perspective of the DHSC in patients with HCC in BCLC B.