Transarterial radioembolization vs transarterial chemoembolization with drug-eluting beads for treating hepatocellular carcinoma: a cost-effectiveness analysis in Japanese healthcare system.

Autor: Shirota G; Department of Radiology, Graduate School of Medicine, The University of Tokyo, 7-3-1 Hongo, Bunkyo-Ku, Tokyo, 113-8655, Japan. gshirota@gmail.com., Sato S; Department of Clinical Epidemiology and Health Economics, School of Public Health, The University of Tokyo, Tokyo, Japan., Yasunaga H; Department of Clinical Epidemiology and Health Economics, School of Public Health, The University of Tokyo, Tokyo, Japan., Aso S; Department of Real-World Evidence, Graduate School of Medicine, The University of Tokyo, Tokyo, Japan., Akahane M; Department of Radiology, International University of Health and Welfare Narita Hospital, Narita, Japan., Itoh D; Department of Diagnostic Radiology, Toranomon Hospital, Tokyo, Japan., Abe O; Department of Radiology, Graduate School of Medicine, The University of Tokyo, 7-3-1 Hongo, Bunkyo-Ku, Tokyo, 113-8655, Japan.
Jazyk: angličtina
Zdroj: Japanese journal of radiology [Jpn J Radiol] 2024 Dec; Vol. 42 (12), pp. 1501-1515. Date of Electronic Publication: 2024 Sep 26.
DOI: 10.1007/s11604-024-01640-1
Abstrakt: Purpose: Transarterial radioembolization (TARE) is effective for unresectable hepatocellular carcinoma; however, it awaits approval in Japan. This study aimed to simulate the cost-effectiveness of TARE over chemoembolization when TARE is approved in Japan and identify the requirements for cost-effectiveness.
Materials and Methods: A Markov model was constructed to analyze the costs and effectiveness associated with TARE and transarterial chemoembolization with drug-eluting beads (DEB-TACE) for 2-month cycles over 5 years. In the primary analysis, the intention-to-treat survival data were used to calculate transition probabilities, whereas the ancillary analysis assessed the per-protocol survival data. DEB-TACE costs were calculated using the Japanese nationwide claims Diagnosis Procedure Combination database between April 2018 and March 2022, whereas TARE costs were estimated using database and international sources. The incremental cost-effectiveness ratio (ICER) was determined based on the payer's perspective and compared with the Japanese willingness-to-pay threshold of 5 million Japanese yen (JPY) (31,250 USD) per quality-adjusted life years (QALY).
Results: From the claims database, 6,986 patients with hepatocellular carcinoma who received DEB-TACE were identified. In the primary analysis, the ICER was 5,173,591 JPY (32,334 USD)/QALY, surpassing the Japanese willingness-to-pay threshold. However, the ancillary analysis showed a lower ICER of 4,156,533 JPY (25,978 USD)/QALY, falling below the threshold. The one-way deterministic sensitivity analysis identified progression-free survival associated with TARE and DEB-TACE, DEB-TACE costs, and radioactive microsphere reimbursement price as key ICER influencers. The primary analysis suggested that setting the reimbursement price of radioactive microspheres below 1.399 million JPY (8,744 USD), approximately 2.8% lower than the price in the United Kingdom, would place the ICER below the Japanese willingness-to-pay threshold.
Conclusions: Under specific conditions, TARE can be a more cost-effective treatment than DEB-TACE. If the reimbursement price of radioactive microspheres is set approximately 2.8% lower than that in the United Kingdom, TARE could be cost-effective compared with DEB-TACE.
Competing Interests: Declarations. Competing interest: The authors have no competing interest to disclose. Ethics approval: We strictly adhered to the ethical guidelines laid out in the Declaration of Helsinki by the World Medical Association. This study was approved by the Ethics Committee of the University of Tokyo (No. 3501-(5)). Consent to participate/publish: Our study fulfilled the necessary conditions to waive the need for informed consent based on the Ethical Guidelines for Medical and Health Research Involving Human Subjects established by the Japanese National Government, which stipulates the requirements for protecting patient anonymity.
(© 2024. The Author(s).)
Databáze: MEDLINE
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