OBJECTIVES: Non-metastasized, non-resectable hepatocellular carcinoma (HCC) in patients with Barcelona clinic liver cancer (BCLC) stages B and, in part, C (≈25%) can be treated by systemic immunotherapy or selective internal radiation therapy (SIRT). Therapies vary in terms of required infrastructure, medical specialization(s), facilities, preparation, conduct, and cost. Our objective was to undertake a cost-effectiveness analysis (CEA) and budget impact analysis (BIA) of SIRT – here: with ⁹⁰Y-labelled glass microspheres (TheraSphere^®) compared to immunotherapy with atezolizumab plus bevacizumab (A+B) – from the perspective of the German statutory health insurance (SHI).

METHODS: A CEA and BIA model was developed in MS Excel. Clinical and cost inputs were sourced from published literature and official databases. The available key studies (IMbrave150 and DOSISPHERE-01) suggest that both strategies are potentially comparable in terms of progression-free survival (PFS) and overall survival in HCC, but a difference in adverse events in favor of SIRT was observed. Accordingly, the CEA model investigates the endpoint “cost per adverse event avoided” and the BIA estimates the impact of shifting current market share to the more cost-effective option. Sensitivity and scenario analyses were performed to account for uncertainty.

RESULTS: The model computed mean annual per-patient costs of €23,001 undergoing SIRT compared to €86,762 for A+B. As SIRT featured a lower number of adverse events compared to A+B, it was the dominant strategy. The market share of SIRT in eligible HCC patients is currently about 25% (n≈500 procedures/year) in Germany. Switching another 25% of eligible patients from systemic therapy to SIRT could hence generate annual savings of approx. €30.7 million to the SHI system. The results were robust in sensitivity and scenario analyses.

CONCLUSIONS: Comparing systemic immunotherapy and personalized radioembolization in the indicated HCC target group, SIRT appears to be the dominating strategy with the potential to generate cost-savings from a German SHI perspective.