Cost-Effectiveness Analysis of Interventional Liver-Directed Therapies for Downstaging of Hepatocellular Carcinoma Before Liver Transplant

Wednesday, March 8, 2023

3:00 PM – 3:09 PM

Location: Phoenix Convention Center, 222C

Featured Presenter(s)

Xiao Wu, MD (she/her/hers)

Resident Physician
University of California, San Francisco

Disclosure information not submitted.

Author/Co-author(s)

AK

Allison Kwong, MD

Instructor
Stanford Healthcare
MH

Michael B. Heller, MD

Health System Clinician
University of California, San Francisco
R. Peter Lokken, MD, MPH, FSIR (he/him/his)

Associate Professor of Clinical Radiology
UCSF Department of Radiology and Biomedical Imaging
Nicholas Fidelman, MD (he/him/his)

Professor
University Of California San Francisco
NM

Neil Mehta, MD

Associate Professor
University of California, San Francisco

Disclosure(s):

Xiao Wu, MD: No financial relationships to disclose

R. Peter Lokken, MD, MPH, FSIR: No financial relationships to disclose

Nicholas Fidelman, MD: Boston Scientific: Research Grant or Support (); Merck: Research Grant or Support (); Sirtex Medical: Research Grant or Support ()

Purpose:

To perform a cost-effectiveness analysis comparing the two most commonly used modalities, transarterial chemoembolization (TACE) and transarterial radioembolization (TARE) for downstaging of hepatocellular carcinoma (HCC) before liver transplant (LT).

Materials and Methods:

A cost-effectiveness analysis was performed comparing TACE and TARE downstaging HCC over a 5-year time horizon from a payer’s perspective. The clinical course, including both successful downstaging leading to LT and failure of downstaging with possible disease progression, were from the United Network for Organ Sharing. The median number of treatments needed for downstaging was from the MERITS-LT consortium (2 in TARE and 3 in TACE cohorts). Costs and effectiveness were measured in US dollars and quality-adjusted life years (QALYs). Probabilistic and deterministic sensitivity analyses were performed.

Results:

TARE achieved a higher effectiveness 2.49 QALY (TACE: 2.31 QALY) at a higher cost $172,965 (TACE: $157,687), with the incremental cost-effectiveness ratio of $85,517 /QALY, making TARE the more cost-effective strategy. The difference in outcome was equivalent to 84.4 days (nearly 3 months) in compensated cirrhosis state. Probabilistic sensitivity analyses showed TARE was more cost-effective in 64.92% of 10,000 Monte Carlo simulations.

TACE was more effective if greater than 84% of patients who received TACE as the initial LRT could receive liver transplant per year (base case: 74.6% from pooled analysis of multiple published cohorts). TARE became more cost-effective when the cost of TACE exceeded $10,638 (base case: $12,722) or when the cost of TARE was lower than $34,023 (base case: $30,609). Subgroup analyses TARE be the more cost-effective strategy if this cohort required one fewer LRT than the TACE cohort.

Conclusion:

TARE is the more cost-effective downstaging strategy for patients with HCC exceeding Milan criteria when compared to TACE.