Cost-effectiveness of selective internal radiation therapy with Y-90 resin microspheres for intermediate- and advanced-stage hepatocellular carcinoma in Brazil.

Autor:	Agirrezabal I; Health Economics, Pricing, Reimbursement and Access, Sirtex Medical Europe GmbH, Bonn, Germany., Pereira Grillo Junior LS; AFECC - Hospital Santa Rita de Cássia, Vitoria, Brazil.; Unimed Vitória - Hospital Unimed Vitória, R. Marins Alvarino, Vitoria, Brazil., Nasser F; Department of Interventional Radiology, Hospital Israelita Albert Einstein, São Paulo, Brazil., Brennan VK; Reimbursement and Market Access, Sirtex Medical United Kingdom Ltd, London, UK., Bugano D; Centro de Oncologia do Hospital Israelita Albert Einstein, São Paulo, Brazil., Galastri FL; Department of Interventional Radiology, Hospital Israelita Albert Einstein, São Paulo, Brazil., da-Silva ALFA; Department of Internal Medicine, Hospital de Clinicas de, Porto Alegre, Brazil.; HTAnalyze Consultoria e Treinamento Ltda, Porto Alegre, Brazil., Shergill S; Reimbursement and Market Access, Sirtex Medical United Kingdom Ltd, London, UK., da Motta-Leal-Filho JM; Instituto do Câncer do Estado de São Paulo, Faculdade de Medicina, Universidade de São Paulo, São Paulo, Brazil.
Jazyk:	angličtina
Zdroj:	Journal of medical economics [J Med Econ] 2023 Jan-Dec; Vol. 26 (1), pp. 731-741.
DOI:	10.1080/13696998.2023.2210475
Abstrakt:	Aims: Hepatocellular carcinoma (HCC) is a severe condition with poor prognosis that places a significant burden on patients, caregivers, and healthcare systems. Selective internal radiation therapy (SIRT) is a treatment available to patients with HCC which addresses some of the limitations of alternative treatment options. A cost-effectiveness analysis was undertaken into the use of SIRT using Y-90 resin microspheres for the treatment of unresectable intermediate- and late-stage HCC in Brazil. Materials and Methods: A partitioned-survival model was developed, including a tunnel state for patients downstaged to receive treatments with curative intent. Sorafenib was the selected comparator, a common systemic treatment in Brazil and for which comparative evidence exists. Clinical data were extracted from published sources of pivotal trials, and effectiveness was measured in quality-adjusted life-years (QALYs) and life-years (LYs). The analysis was conducted from the Brazilian private payer perspective and a lifetime horizon was implemented. Comprehensive sensitivity analyses were conducted. Results: LYs and QALYs were higher for SIRT with Y-90 resin microspheres versus sorafenib (0.27 and 0.20 incremental LYs and QALYs, respectively) and costs were slightly higher for SIRT (R$15,864). The base case incremental cost-effectiveness ratio (ICER) was R$77,602 per QALY. The ICER was mostly influenced by parameters defining the sorafenib overall survival curve and SIRT had a 73% probability of being cost-effective at a willingness-to-pay threshold of R$135,761 per QALY (3-times the per-capita gross domestic product in Brazil). Overall, sensitivity analyses confirmed the robustness of the results indicating that SIRT with Y-90 resin microspheres is cost-effective compared with sorafenib. Limitations: A rapidly evolving treatment landscape in Brazil and worldwide, and the lack of local data for some variables were the main limitations. Conclusions: SIRT with Y-90 resin microspheres is a cost-effective option compared with sorafenib in Brazil.
Databáze:	MEDLINE
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