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Randomized Controlled Trial
. 2021 Jul;43(7):1201-1212.
doi: 10.1016/j.clinthera.2021.04.018. Epub 2021 May 28.

Cost-Utility Analysis of Transarterial Radioembolization With Yttrium-90 Resin Microspheres Compared With Sorafenib in Locally Advanced and Inoperable Hepatocellular Carcinoma

Kevin Zarca  1 , Maroua Mimouni  2 , Helena Pereira  3 , Gilles Chatellier  3 , Valérie Vilgrain  4 , Isabelle Durand-Zaleski  5 ; SARAH Trial Group
Collaborators, Affiliations
Randomized Controlled Trial

Cost-Utility Analysis of Transarterial Radioembolization With Yttrium-90 Resin Microspheres Compared With Sorafenib in Locally Advanced and Inoperable Hepatocellular Carcinoma

Kevin Zarca et al. Clin Ther. 2021 Jul.

Abstract

Purpose: The SARAH (Sorafenib Versus Radioembolization in Advanced Hepatocellular Carcinoma) trial (ClinicalTrials.gov Identifier NCT01482442) did not show a significant survival benefit for patients treated with transarterial radioembolization (TARE) compared with continuous oral sorafenib. The improved toxicity profile of patients treated with TARE in the trial, however, could result in a quality of life benefit in economic evaluations. Our objective was to perform a cost-utility analysis of TARE versus sorafenib for locally advanced and inoperable hepatocellular carcinoma.

Methods: This study used patient-level data of the SARAH trial regarding resource use, progression-free and overall survival, and quality of life for the within-trial period for the patients who received at least 1 dose of sorafenib or 1 treatment with TARE according to their randomization arm. Data were extrapolated by using a partitioned survival model that incorporated costs and health outcomes, measured in life-years and quality-adjusted life-years (QALYs).

Findings: The use of TARE resulted in an average loss of 0.036 life-year and a gain of 0.006 QALY compared with sorafenib. The aerage cost for the TARE arm was €17,179 (95% CI, 9,926-24,280) higher than the sorafenib arm, for an incremental cost-effectiveness ratio of €3,153,086/QALY. The probabilistic sensitivity analysis revealed a 50% risk that the TARE strategy was dominated. TARE was consistently dominated by sorafenib or had an incremental cost-effectiveness ratio more than €450,000/QALY in all sensitivity analyses.

Implications: This economic evaluation of SARAH found that using radioembolization with yttrium-90 microspheres for the treatment of hepatocellular carcinoma was not a cost-effective option at the usually accepted willingness-to-pay thresholds.

Keywords: cost-utility analysis; hepatocellular carcinoma; sorafenib; survival analysis; yttrium radioisotopes.

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Conflict of interest statement

DISCLOSURES Dr. Vilgrain reports research grants and personal fees from SIRTEX during the conduct of the randomized controlled trial. The authors have indicated that they have no other conflicts of interest regarding the content of this article. Neither the sponsor nor the funder of the study had any role in study design, data collection, data analysis, or data interpretation. The publication of study results was not contingent on the sponsor's approval or censorship of the manuscript.

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