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 drug eluting bead transarterial chemoembolization (DEB-TACE) in treating patients with BCLC B HCC in England.

METHODS:

A budget impact analysis was conducted over a three-year time horizon from the Department of Health and Social Care (DHSC) perspective, capturing treatment and adverse event (AE) costs. Costs of the SIRT and DEB-TACE procedures were obtained from the National Tariff 2022/23. Costs of drug-eluting beads and Y-90 resin microspheres were obtained from peer-reviewed literature and manufacturer list prices, respectively. Grade 3/4 AEs were modeled based on the SARAH randomized controlled trial (RCT). The number of DEB-TACE procedures per patient was based on a separate 2015 RCT; the number of SIRT procedures was based on recommended standard of care in recent trials. Analyses were run for “same-stay” SIRT with the Order-Map-Treat Program (a single hospital spell for work-up and procedure) and then with separate hospital spells for work-up and procedure. Subsequent systemic treatment utilisation was informed by expert opinion and costed from the British National Formulary.

RESULTS:

Compared with DEB-TACE, “same-stay” SIRT resulted in cost savings of GBP 6,536 per patient (GBP 34,892 versus GBP 41,428). Savings with SIRT in which the work-up was performed during a separate hospital spell from the procedure were lower, saving GBP 4,192 versus DEB-TACE (GBP 37,236 versus GBP 41,428). The analysis was sensitive to the number of SIRT and DEB-TACE procedures performed per-patient and treatment progression assumptions.

CONCLUSIONS:

The analysis showed that same-stay SIRT using SIR-Spheres Y-90 resin microspheres would be cost saving versus DEB-TACE from a DHSC perspective in patients with HCC in BCLC B in England.