The SARAH phase III randomized controlled trial (RCT) compared selective internal radiation therapy (SIRT) using SIR-Spheres®yttrium-90 (Y-90) resin microspheres with sorafenib in patients with inoperable hepatocellular carcinoma (HCC). While overall survival (OS) was not significantly different, quality of life as measured by the EORTC-QLQ-C30 was significantly better in the SIRT group, likely owing to the improved safety profile. The objective of the present study was to conduct a cost-effectiveness analysis of SIRT versus sorafenib from a French collective perspective.

The model projected that sorafenib and SIRT would result in mean life expectancy of 1.24 and 1.25 years respectively, with SIRT resulting in an increase in quality-adjusted life years (QALYs) of 0.031 QALYs, from 0.747 to 0.779 QALYs. SIRT was associated with a reduction in cost of EUR 3,437, from EUR 34,096 with sorafenib to EUR 30,660, resulting in SIRT being dominant relative to sorafenib. Cost savings were driven primarily by reductions in the incidence of adverse events. One-way and probabilistic sensitivity analyses showed the results to be robust and broadly insensitive to changes in most model parameters.

SIRT would both improve quality of life and reduce costs in patients with inoperable HCC in France, with improvements being driven primarily by better tolerability relative to sorafenib. SIRT therefore represents an efficacious and cost-effective choice in patients with inoperable HCC in France.