Measuring and modeling patient quality of life is critically important in the evaluation of the cost-effectiveness of any health intervention, with quality of life arguably being the most important consideration in patients for whom a meaningful extension of life is not feasible. In the present study, we aimed to identify cost-utility analyses comparing selective internal radiation therapy (SIRT) with systemic therapy in patients with unresectable hepatocellular carcinoma (HCC) and to compare the modeled incremental quality of life differences between the two therapies.

A systematic literature review was conducted. PubMed, EMBASE, the Cochrane Library, and health technology assessment agency websites were searched to identify cost-utility studies of SIRT versus systemic therapies in the treatment of HCC. Incremental quality of life outcomes were extracted from the included studies, and the magnitudes of incremental quality of life measures were ranked in descending order to illustrate the range and distribution of values.

The systematic literature review retrieved 1,140 studies, of which four were ultimately included, plus two analyses identified from hand searches. From the six studies, 13 analyses were ultimately considered, with incremental quality of life estimates spanning -0.09 to +0.28 quality-adjusted life years (QALYs) based on analysis using data from the overall trial populations, or -0.09 to +0.60 QALYs when also considering post hoc sub-group analyses.

The wide range of incremental QALYs, with substantial differences between the overall trial populations and subgroups, illustrates the impact the choice of target population may have on cost-effectiveness results. It also highlights both the importance of reporting measures of dispersion around the findings, and the limitations of the incremental cost-effectiveness ratio (ICER) for assessing the relative cost-effectiveness of interventions that are predicted to result in similar quality of life outcomes.