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Cost-effectiveness analysis of treatment with non-curative or palliative intent for hepatocellular carcinoma in the real-world setting

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  • Hla-Hla Thein
  • Yao Qiao
  • Ahmad Zaheen
  • Nathaniel Jembere
  • Gonzalo Sapisochin
  • Kelvin K W Chan
  • Eric M Yoshida
  • Craig C Earle

Abstract

Hepatocellular carcinoma (HCC) presentation is heterogeneous necessitating a variety of therapeutic interventions with varying efficacies and associated prognoses. Poor prognostic patients often undergo non-curative palliative interventions including transarterial chemoembolization (TACE), sorafenib, chemotherapy, or purely supportive care. The decision to pursue one of many palliative interventions for HCC is complex and an economic evaluation comparing these interventions has not been done. This study evaluates the cost-effectiveness of non-curative palliative treatment strategies such as TACE alone or TACE+sorafenib, sorafenib alone, and non-sorafenib chemotherapy compared with no treatment or best supportive care (BSC) among patients diagnosed with HCC between 2007 and 2010 in a Canadian setting. Using person-level data, we estimated effectiveness in life years and quality-adjusted life years (QALYs) along with total health care costs (2013 US dollars) from the health care payer’s perspective (3% annual discount). A net benefit regression approach accounting for baseline covariates with propensity score adjustment was used to calculate incremental net benefit to generate incremental cost-effectiveness ratio (ICER) and uncertainty measures. Among 1,172 identified patients diagnosed with HCC, 4.5%, 7.9%, and 5.6%, received TACE alone or TACE+sorafenib, sorafenib, and non-sorafenib chemotherapy clone, respectively. Compared with no treatment or BSC (81.9%), ICER estimates for TACE alone or TACE+sorafenib was $6,665/QALY (additional QALY: 0.47, additional cost: $3,120; 95% CI: -$18,800-$34,500/QALY). The cost-effectiveness acceptability curve demonstrated that if the relevant threshold was $50,000/QALY, TACE alone or TACE+sorafenib, non-sorafenib chemotherapy, and sorafenib alone, would have a cost-effectiveness probability of 99.7%, 46.6%, and 5.5%, respectively. Covariates associated with the incremental net benefit of treatments are age, sex, comorbidity, and cancer stage. Findings suggest that TACE with or without sorafenib is currently the most cost-effective active non-curative palliative treatment approach to HCC. Further research into new combination treatment strategies that afford the best tumor response is needed.

Suggested Citation

  • Hla-Hla Thein & Yao Qiao & Ahmad Zaheen & Nathaniel Jembere & Gonzalo Sapisochin & Kelvin K W Chan & Eric M Yoshida & Craig C Earle, 2017. "Cost-effectiveness analysis of treatment with non-curative or palliative intent for hepatocellular carcinoma in the real-world setting," PLOS ONE, Public Library of Science, vol. 12(10), pages 1-20, October.
    • Handle: RePEc:plo:pone00:0185198
    DOI: 10.1371/journal.pone.0185198
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    References listed on IDEAS

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    1. Nathaniel Jembere & Michael A Campitelli & Morris Sherman & Jordan J Feld & Wendy Lou & Stuart Peacock & Eric Yoshida & Murray D Krahn & Craig Earle & Hla-Hla Thein, 2012. "Influence of Socioeconomic Status on Survival of Hepatocellular Carcinoma in the Ontario Population; A Population-Based Study, 1990–2009," PLOS ONE, Public Library of Science, vol. 7(7), pages 1-10, July.
    2. Leida Zhang & Peng Hu & Xi Chen & Ping Bie, 2014. "Transarterial Chemoembolization (TACE) plus Sorafenib Versus TACE for Intermediate or Advanced Stage Hepatocellular Carcinoma: A Meta-Analysis," PLOS ONE, Public Library of Science, vol. 9(6), pages 1-8, June.
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    1. Elizabeth Parody-Rúa & Maria Rubio-Valera & César Guevara-Cuellar & Ainhoa Gómez-Lumbreras & Marc Casajuana-Closas & Cristina Carbonell-Duacastella & Ignacio Aznar-Lou, 2020. "Economic Evaluations Informed Exclusively by Real World Data: A Systematic Review," IJERPH, MDPI, vol. 17(4), pages 1-18, February.

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