1
|
Ye T, Shao SH, Ji K, Yao SL. Evaluation of short-term effects of drug-loaded microspheres and traditional transcatheter arterial chemoembolization in the treatment of advanced liver cancer. World J Gastrointest Oncol 2022; 14:2367-2379. [PMID: 36568947 PMCID: PMC9782616 DOI: 10.4251/wjgo.v14.i12.2367] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/01/2022] [Revised: 08/29/2022] [Accepted: 11/17/2022] [Indexed: 12/12/2022] Open
Abstract
BACKGROUND Liver cancer is a malignant tumor with high morbidity and mortality. Transcatheter arterial chemoembolization (TACE) is the main method for surgically unresectable liver cancer. In recent years, drug-loaded microspheres have been gradually applied in TACE technology. There are some controversies about the therapeutic effects of drug-loaded microspheres TACE (D-TACE) and traditional TACE.
AIM To explore the short-term efficacy of D-TACE and traditional TACE in the treatment of advanced liver cancer.
METHODS The clinical data of 73 patients with advanced liver cancer admitted to the First and Sixth Medical Centers of Chinese PLA General Hospital from January 2017 to October 2019 were retrospectively analyzed. Among them, 15 patients were treated with D-TACE, and 58 patients were treated with traditional TACE. Clinical baseline characteristics, perioperative laboratory indices, postoperative adverse reactions and postoperative complications were compared between the two groups.
RESULTS There was no statistical difference between the two groups for the postoperative response: The highest postoperative body temperature of the drug-loaded microsphere group was 38.0 ± 0.9℃ and the postoperative highest body temperature of the traditional TACE group was 38.3 ± 0.7℃ (t = -1.414, P = 0.162). For the 24 h postoperative nausea and vomiting after surgery in terms of scoring and postoperative pain scores, the traditional TACE group was higher than the drug-loaded microsphere group (χ2 = 14.33, P = 0.014; χ2 = 32.967, P = 0.000) and the two groups had significant statistical differences. The disease control rate at 3 mo after treatment in the drug-loaded microsphere group was 60% and the disease control rate at 3 mo after treatment in the traditional TACE group was 75.9% (χ2 = 4.091, P = 0.252). There was no statistical difference between the two groups of data. During the follow-up period, the number of interventional treatments received was once in the drug-loaded microsphere group and the traditional TACE group received an average of 1.48 treatments (χ2 = 10.444 P = 0.005). There was a statistical difference between the two groups.
CONCLUSION Compared with traditional TACE, D-TACE may have some advantages in the treatment of advanced hepatocellular carcinoma with a large tumor load in the short term, but the long-term clinical efficacy needs additional follow-up studies. In addition, compared with the traditional group, the patients in the drug-loaded microsphere group had better subjective tolerance and could reduce the number of interventional treatments. Therefore, D-TACE is worthy of clinical promotion.
Collapse
Affiliation(s)
- Ting Ye
- Department of Nuclear Medicine, First Medical Center, PLA General Hospital, Beijing 100039, China
| | - Shi-Han Shao
- Department of Hepatobiliary Surgery, The Sixth Medical Center, PLA General Hospital, Beijing 100048, China
| | - Kan Ji
- Department of Interventional Radiology, First Medical Center, PLA General Hospital, Beijing 100071, China
| | - Shu-Lin Yao
- Department of Nuclear Medicine, First Medical Center, PLA General Hospital, Beijing 100039, China
| |
Collapse
|
2
|
Alonso JC, Casans I, González FM, Fuster D, Rodríguez A, Sánchez N, Oyagüez I, Burgos R, Williams AO, Espinoza N. Economic evaluations of radioembolization with Itrium-90 microspheres in hepatocellular carcinoma: a systematic review. BMC Gastroenterol 2022; 22:326. [PMID: 35780112 PMCID: PMC9250253 DOI: 10.1186/s12876-022-02396-6] [Citation(s) in RCA: 6] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/29/2022] [Accepted: 06/20/2022] [Indexed: 11/20/2022] Open
Abstract
Background Transarterial radioembolization (TARE) with yttrium-90 microspheres is a clinically effective therapy for hepatocellular carcinoma (HCC) treatment. This study aimed to perform a systematic review of the available economic evaluations of TARE for the treatment of HCC. Methods The Preferred Reported Items for Systematic reviews and Meta-Analyses guidelines was followed by applying a search strategy across six databases. All studies identified as economic evaluations with TARE for HCC treatment in English or Spanish language were considered. Costs were adjusted using the 2020 US dollars based on purchasing-power-parity ($US PPP). Results Among 423 records screened, 20 studies (6 cost-analyses, 3 budget-impact-analyses, 2 cost-effectiveness-analyses, 8 cost-utility-analyses, and 1 cost-minimization analysis) met the pre-defined criteria for inclusion. Thirteen studies were published from the European perspective, six from the United States, and one from the Canadian perspectives. The assessed populations included early- (n = 4), and intermediate-advanced-stages patients (n = 15). Included studies were evaluated from a payer perspective (n = 20) and included both payer and social perspective (n = 2). TARE was compared with transarterial chemoembolization (TACE) in nine studies or sorafenib (n = 11). The life-years gained (LYG) differed by comparator: TARE versus TACE (range: 1.3 to 3.1), and TARE versus sorafenib (range: 1.1 to 2.53). Of the 20 studies, TARE was associated with lower treatment costs in ten studies. The cost of TARE treatment varied widely according to Barcelona Clinic Liver Cancer (BCLC) staging system and ranged from 1311 $US PPP/month (BCLC-A) to 71,890 $US PPP/5-years time horizon (BCLC-C). The incremental cost-utility ratio for TARE versus TACE resulted in a 17,397 $US PPP/Quality-adjusted-Life-Years (QALY), and for TARE versus sorafenib ranged from dominant (more effectiveness and lower cost) to 3363 $US PPP/QALY. Conclusions Economic evaluations of TARE for HCC treatment are heterogeneous. Overall, TARE is a cost-effective short- and long-term therapy for the treatment of intermediate-advanced HCC. Supplementary Information The online version contains supplementary material available at 10.1186/s12876-022-02396-6.
Collapse
Affiliation(s)
- J C Alonso
- Nuclear Medicine Department, Hospital Gregorio Marañón, Madrid, Spain
| | - I Casans
- Nuclear Medicine Department, Hospital Clínico Universitario, Valencia, Spain
| | - F M González
- Nuclear Medicine Department, Hospital Universitario Central, Asturias, Spain
| | - D Fuster
- Nuclear Medicine Department, Hospital Clinic, Barcelona, Spain
| | - A Rodríguez
- Nuclear Medicine Department, Hospital Virgen de las Nieves, Granada, Spain
| | - N Sánchez
- Nuclear Medicine Department, Hospital Clinic, Barcelona, Spain
| | - I Oyagüez
- Pharmacoeconomics & Outcomes Research Iberia (PORIB), P. Joaquín Rodrigo 4 - letra I, 28224, Pozuelo de Alarcón, Madrid, Spain
| | - R Burgos
- Boston Scientific Iberia, Madrid, Spain
| | | | - N Espinoza
- Pharmacoeconomics & Outcomes Research Iberia (PORIB), P. Joaquín Rodrigo 4 - letra I, 28224, Pozuelo de Alarcón, Madrid, Spain.
| |
Collapse
|
3
|
Impact of metabolic surgery on cost and long-term health outcome: a cost-effectiveness approach. Surg Obes Relat Dis 2021; 18:260-270. [PMID: 34782294 DOI: 10.1016/j.soard.2021.10.012] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/06/2020] [Revised: 09/20/2021] [Accepted: 10/13/2021] [Indexed: 11/21/2022]
Abstract
BACKGROUND The increase in obesity has become a major public health concern. Morbid obesity is associated with co-morbidities, reduced quality-of-life, and death. Metabolic surgery (MS) is the most effective treatment for obesity. OBJECTIVES The aim of this study was to evaluate the costs and outcomes of MS compared with no surgery in patients with a body mass index ≥30 kg/m2. SETTING Health care system, Austria METHODS: A total of 177 patients who underwent MS were documented retrospectively, based on the hospital records of 2 specialized centers in Austria, over a 1-year period. At baseline 26.0% of patients exhibited type 2 diabetes (T2D), 52.5% cardiovascular disease (CVD), 23.2% hyperlipidemia, and 23.7% depression. Following the observation period, a Markov chain simulation model was developed to analyze the long-term consequences of T2D, including diabetic complications, CVD, hyperlipidemia, depression, non-alcoholic steatohepatitis (NASH), myocardial infarction, and stroke, over a total of 20 years. Direct medical costs were expressed in 2017 euros from the payer's perspective. Quality-adjusted life years (QALYs), life years (LYs), and costs were discounted. RESULTS MS led to costs of €40,427 and 9.58 QALYs (15.58 LYs) per patient over 20 years. No MS was associated with €64,819 and 6.33 QALYs (13.92 LYs). Total cost-savings amounted to €24,392, which offset the cost of the procedure including re-operations. Over 20 years MS saved -6.7 patient-years per patient with T2D, -5.8 patient-years with CVD, -1.5 patient-years with hyperlipidemia, -1.8 patient-years with depression, and -3.8 patient-years with NASH. CONCLUSION MS is associated with substantial savings in long-term costs, expected health benefits, and reduced onset of complications. MS significantly increases quality of life.
Collapse
|
4
|
Terashima T, Higashibeppu Y, Yamashita T, Sakata Y, Azuma M, Fujimoto K, Munakata H, Ishii M, Kaneko S. Treatment patterns and medical costs after hepatectomy in real-world practice for patients with hepatocellular carcinoma in Japan. Hepatol Res 2021; 51:1073-1081. [PMID: 34288302 DOI: 10.1111/hepr.13701] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/15/2021] [Revised: 06/21/2021] [Accepted: 07/12/2021] [Indexed: 02/08/2023]
Abstract
AIM To examine the treatment patterns and medical costs in real-world practice among patients who received hepatectomy for hepatocellular carcinoma (HCC) in Japan. METHODS Data of patients who underwent hepatectomy as an initial therapy for primary HCC were extracted from a Japanese medical claims database from April 2008 to December 2019. The types of additional treatments for recurrent HCC and medical costs for up to 3 years from the first hepatectomy were analyzed. The average cumulative cost per patient starting on the date of the first hepatectomy was calculated using the Kaplan-Meier sample-average method. RESULTS Data from 2 342 patients (median age, 71 years) were analyzed. Overall, 35.6% of patients received at least one HCC treatment within 3 years of the first hepatectomy. The total average cumulative 3-years medical cost was JPY 4 993 300 (95% confidence interval [CI]: 4 804 100 to 5 220 500). Surgical procedures were the most costly components in the first month after hepatectomy, whereas the costs of drugs, which mainly included antiviral and antineoplastic medications, increased thereafter. Patients with advanced stage HCC, hepatitis C, or a higher Charlson Comorbidity Index at hepatectomy, or those who required additional treatment, especially with antineoplastic drugs for recurrent HCC, incurred higher medical costs. CONCLUSIONS Patients with HCC after hepatectomy experienced a large economic burden, which was more serious for those with advanced stage HCC, higher comorbidities, and hepatitis at baseline and for patients treated with antineoplastic drugs. A treatment selection that considers its medical cost burden would help to reduce some of these economic burdens.
Collapse
Affiliation(s)
- Takeshi Terashima
- Department of Gastroenterology, Kanazawa University Hospital, Kanazawa, Japan
| | - Yoichi Higashibeppu
- Clinical Planning and Development Department, Medical Headquarters, Eisai Co., Ltd., Tokyo, Japan
| | - Tatsuya Yamashita
- Department of Gastroenterology, Kanazawa University Hospital, Kanazawa, Japan
| | - Yukinori Sakata
- Clinical Planning and Development Department, Medical Headquarters, Eisai Co., Ltd., Tokyo, Japan
| | - Mie Azuma
- Clinical Planning and Development Department, Medical Headquarters, Eisai Co., Ltd., Tokyo, Japan
| | - Kenichi Fujimoto
- Clinical Planning and Development Department, Medical Headquarters, Eisai Co., Ltd., Tokyo, Japan
| | - Hiroaki Munakata
- Clinical Planning and Development Department, Medical Headquarters, Eisai Co., Ltd., Tokyo, Japan
| | - Mika Ishii
- Clinical Planning and Development Department, Medical Headquarters, Eisai Co., Ltd., Tokyo, Japan
| | - Shuichi Kaneko
- Department of Gastroenterology, Kanazawa University Hospital, Kanazawa, Japan
| |
Collapse
|
5
|
Aly A, Lingohr-Smith M, Lin J, Seal B. Locoregional therapy patterns and healthcare economic burden of patients with hepatocellular carcinoma in the USA. Hepat Oncol 2021; 8:HEP37. [PMID: 34408847 PMCID: PMC8369525 DOI: 10.2217/hep-2021-0001] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/28/2021] [Accepted: 03/24/2021] [Indexed: 11/23/2022] Open
Abstract
Aim: To examine the locoregional therapy (LRT) patterns and the healthcare economic burden of patients with hepatocellular carcinoma (HCC) in the USA. Patients & methods: Patients with newly diagnosed HCC were identified from the MarketScan® databases (1 July 2015–31 May 2018). The LRTs received and all-cause and HCC-related healthcare costs were measured. Results: Among 2101 patients with HCC, most received embolization therapy as their first LRT treatment (57.8%, n = 1215); 17.1% (n = 360) received ablative therapy and 8.7% (n = 182) radiation therapy; 16.4% (n = 344) received multiple LRTs. After patients received their first LRT treatment, total all-cause healthcare costs averaged $20,316 per patient per month; 70.7% ($14,359) were HCC related. Conclusion: Among newly diagnosed HCC patients treated with LRT in the USA, the economic burden is high.
Collapse
Affiliation(s)
- Abdalla Aly
- AstraZeneca Pharmaceuticals LP, US Medical Affairs: Evidence Generation, Gaithersburg, MD 20878, USA
| | | | - Jay Lin
- Novosys Health, Green Brook, NJ 08812, USA
| | - Brian Seal
- AstraZeneca Pharmaceuticals LP, US Medical Affairs: Evidence Generation, Gaithersburg, MD 20878, USA
| |
Collapse
|
6
|
Ljuboja D, Ahmed M, Ali A, Perez E, Subrize MW, Kaplan RS, Sarwar A. Time-Driven Activity-Based Costing in Interventional Oncology: Cost Measurement and Cost Variability for Hepatocellular Carcinoma Therapies. J Am Coll Radiol 2021; 18:1095-1105. [PMID: 33939974 DOI: 10.1016/j.jacr.2021.03.027] [Citation(s) in RCA: 8] [Impact Index Per Article: 2.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/03/2021] [Revised: 03/24/2021] [Accepted: 03/28/2021] [Indexed: 01/09/2023]
Abstract
PURPOSE To use time-drive activity-based costing (TDABC) to characterize and compare costs of transarterial chemoembolization (TACE), transarterial radioembolization (TARE), and ablation. METHODS This three-part study involved (1) prospective observation to record resources used during TACE, TARE, and ablation and statistical evaluation of interobserver and interprocedure variability; (2) Bland-Altman analysis of prospective measurements and medical record time stamps to establish practicality of using retrospective data in place of direct observation; (3) retrospective time stamp assessment for 117 ablations, 61 TACE procedures, and 61 TARE procedures to reveal variability drivers. RESULTS Ablation costs were lowest ($3,744), which were 74% of TACE costs ($5,089) and 18% of TARE costs ($20,818). Consumables were the greatest cost contributor, accounting for 65% of ablation, 58% of TACE, and 90% of TARE costs. A single consumable contributed to most of the overall costs: the ablation probe (42%), ethiodized oil for TACE (30%), and yttrium-90 microspheres for TARE (80%). Bland-Altman analysis showed agreement between retrospective time stamps and prospective measurements. Ablation costs increased from $3,288 to $4,245 to $4,461 for one, two, or three tumors treated. TACE cost increased from $5,051 to $5,296 for lobar versus selective approaches. CONCLUSION A bottom-up costing approach using TDABC is feasible to assess true costs of hepatocellular carcinoma treatments and demonstrates ablation costs are significantly less than those of TACE and TARE. Replication of these methods at other institutions can facilitate development of a bundled payment model to promote utilization of locoregional therapies for hepatocellular carcinoma.
Collapse
Affiliation(s)
- Damir Ljuboja
- Harvard Medical School, Boston, Massachusetts; Harvard Business School, Boston, Massachusetts; Department of Radiology, Division of Vascular and Interventional Radiology, Beth Israel Deaconess Medical Center/Harvard Medical School, Boston, Massachusetts; Newton-Wellesley Hospital, Newton, Massachusetts.
| | - Muneeb Ahmed
- Chief, Division of Vascular and Interventional Radiology, Beth Israel Deaconess Medical Center/Harvard Medical School, Boston, Massachusetts
| | - Aamir Ali
- Department of Radiology, Division of Vascular and Interventional Radiology, Beth Israel Deaconess Medical Center/Harvard Medical School, Boston, Massachusetts
| | - Enio Perez
- Harvard School of Public Health, Boston, Massachusetts
| | - Michael W Subrize
- Department of Radiology, Division of Vascular and Interventional Radiology, Beth Israel Deaconess Medical Center/Harvard Medical School, Boston, Massachusetts
| | - Robert S Kaplan
- Senior Fellow and Marvin Bower Professor of Leadership Development, Emeritus at the Harvard Business School, Boston, Massachusetts
| | - Ammar Sarwar
- Co-Director Liver Tumor Program, Division of Vascular and Interventional Radiology, Beth Israel Deaconess Medical Center/Harvard Medical School, Boston, Massachusetts
| |
Collapse
|
7
|
Villani R, Cavallone F, Sangineto M, Fioravanti G, Romano AD, Serviddio G. Management of intermediate-stage hepatocellular carcinoma in the elderly with transcatheter arterial chemoembolization failure: Retreatment or switching to systemic therapy? Int J Clin Pract 2021; 75:e13733. [PMID: 32981175 DOI: 10.1111/ijcp.13733] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/07/2020] [Accepted: 09/18/2020] [Indexed: 12/25/2022] Open
Abstract
BACKGROUND Transcatheter Arterial chemoembolization (TACE) is the first-line option for the intermediate-stage hepatocellular carcinoma. Guidelines do not define the number of TACE sessions to be repeated before stopping treatment and switching to sorafenib. METHODS We retrospectively analysed 76 patients aged ≥65 years who were treated by multiple TACE sessions (re-TACE group; N = 36 patients) or one TACE session followed by sorafenib (TACE/Sorafenib group; N = 40 patients). The primary outcome was the overall survival (Kaplan-Meier analysis and log-rank test). RESULTS Median overall survival was 320 days (range: 70-420 days) in re-TACE subgroup and 285 days (range: 50-368 days) in TACE/Sorafenib subgroup without significant differences between the two groups (log-rank test P = .72; HR = 0.87; 95% IC 0.41-1.87). The survival rate at one year was 43.6% and 32% in the re-TACE and in the TACE/sorafenib groups (P = .12), respectively. Subgroup analysis by gender, number of nodules at baseline and etiology of liver cirrhosis was performed but no differences were found. No statistical difference was observed in the frequency of side effects, but sorafenib was associated with severe diarrhoea in most patients requiring dose reduction. CONCLUSION In our study including HCC patients aged ≥65 years, no differences in survival rate and side effects were found between patients Retreated with further TACE sessions and patients with treatment stage migration to sorafenib after first TACE failure. We included in our analysis a small study population; therefore, larger prospective studies are needed to confirm these findings.
Collapse
Affiliation(s)
- Rosanna Villani
- C.U.R.E. (University Centre for Liver Disease Research and Treatment), Liver Unit, Department of Medical and Surgical Sciences, University of Foggia, Foggia, Italy
| | - Francesco Cavallone
- C.U.R.E. (University Centre for Liver Disease Research and Treatment), Liver Unit, Department of Medical and Surgical Sciences, University of Foggia, Foggia, Italy
| | - Moris Sangineto
- C.U.R.E. (University Centre for Liver Disease Research and Treatment), Liver Unit, Department of Medical and Surgical Sciences, University of Foggia, Foggia, Italy
| | - Gilda Fioravanti
- C.U.R.E. (University Centre for Liver Disease Research and Treatment), Liver Unit, Department of Medical and Surgical Sciences, University of Foggia, Foggia, Italy
| | - Antonino Davide Romano
- C.U.R.E. (University Centre for Liver Disease Research and Treatment), Liver Unit, Department of Medical and Surgical Sciences, University of Foggia, Foggia, Italy
| | - Gaetano Serviddio
- C.U.R.E. (University Centre for Liver Disease Research and Treatment), Liver Unit, Department of Medical and Surgical Sciences, University of Foggia, Foggia, Italy
| |
Collapse
|
8
|
Lanza E, Muglia R, Bolengo I, Poretti D, D’Antuono F, Ceriani R, Torzilli G, Pedicini V. Survival analysis of 230 patients with unresectable hepatocellular carcinoma treated with bland transarterial embolization. PLoS One 2020; 15:e0227711. [PMID: 31935255 PMCID: PMC6959584 DOI: 10.1371/journal.pone.0227711] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/09/2019] [Accepted: 12/24/2019] [Indexed: 02/06/2023] Open
Abstract
Locoregional therapies for hepatocellular carcinoma (HCC) include endovascular treatments such as chemoembolization (TACE) and bland embolization (TAE). TACE is the most adopted technique, despite a lack of definitive evidence of superiority over TAE, which is less costly and better tolerated due to the absence of chemotherapy. However, few studies have reported data on TAE monotherapy for unresectable HCC. We report our results in a cohort of 230 patients with unresectable HCC treated with TAE (TAE with 40-100micron microparticles, TAE with microparticles plus n-butyl-2-cyanoacrylate, TAE with Lipiodol) over the course of seven years. Thirty-seven patients (14%) were down-staged during observation and also received a percutaneous ablation. We observed 1-, 2-, 3-, 4- and 5-year rates of 84,8%, 58,7%, 38,3%, 28,3%, and 18,7%. Patients who also received percutaneous treatment performed best. Our results broaden the body of evidence for the use of TAE in advanced HCC.
Collapse
Affiliation(s)
- Ezio Lanza
- Department of Diagnostic and Interventional Radiology, Humanitas Clinical and Research Hospital IRCCS, Rozzano, Milan, Italy
- * E-mail:
| | - Riccardo Muglia
- Training School in Radiology, Humanitas University, Pieve Emanuele, Milan, Italy
| | - Isabella Bolengo
- Training School in Radiology, Humanitas University, Pieve Emanuele, Milan, Italy
| | - Dario Poretti
- Department of Diagnostic and Interventional Radiology, Humanitas Clinical and Research Hospital IRCCS, Rozzano, Milan, Italy
| | - Felice D’Antuono
- Department of Diagnostic and Interventional Radiology, Humanitas Clinical and Research Hospital IRCCS, Rozzano, Milan, Italy
| | - Roberto Ceriani
- Department of Internal Medicine - Hepatology, Humanitas Clinical and Research Hospital IRCCS, Rozzano, Milan, Italy
| | - Guido Torzilli
- Department of Surgery - Hepatobiliary and General Surgery, Humanitas Clinical and Research Hospital IRCCS, Rozzano, Milan, Italy
| | - Vittorio Pedicini
- Department of Diagnostic and Interventional Radiology, Humanitas Clinical and Research Hospital IRCCS, Rozzano, Milan, Italy
| |
Collapse
|
9
|
Treatment and Cost of Hepatocellular Carcinoma: A Population-Based Cohort Study in Taiwan. INTERNATIONAL JOURNAL OF ENVIRONMENTAL RESEARCH AND PUBLIC HEALTH 2018; 15:ijerph15122655. [PMID: 30486324 PMCID: PMC6313960 DOI: 10.3390/ijerph15122655] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 10/02/2018] [Revised: 11/08/2018] [Accepted: 11/20/2018] [Indexed: 02/07/2023]
Abstract
Hepatitis B virus vaccination and antiviral therapies reduce the risk of hepatocellular carcinoma (HCC). However, the lifetime healthcare expenditure involved in caring for HCC patients remains unclear. We examined the use and direct costs of healthcare services for a cohort of HCC patients to the healthcare system using Taiwan national health insurance program research database between 1997 and 2012. Total medical cost for all reimbursed patient encounters, including hospitalizations and outpatient care was cumulated from HCC onset to the end of follow-up or death. The mean follow-up time was 2.7 years (standard deviation, SD = 3.3) for the entire HCC cohort. Insurance payments of approximately US$92 million were made to 5522 HCC patients, with a mean cost of US$16,711 per patient (21,350). On average, the total cost per patient per month was US$2143 (5184); it was 50% higher for advanced cirrhosis patients at the baseline but 23% lower for mild-to-moderate cirrhotic patients. In the two-part regression, patients’ underlying comorbid conditions, liver transplants, hepatectomy, and transarterial chemoembolization were associated with increased total cost, with liver transplants having the greatest impact over time. Hepatocellular carcinoma imposes substantial burden on the healthcare system. Real-world evidence on treatment and cost outcomes highlighted the needs to expand effective screening strategies and to optimize healthcare delivery to meet HCC patients’ clinical needs.
Collapse
|
10
|
Rognoni C, Ciani O, Sommariva S, Bargellini I, Bhoori S, Cioni R, Facciorusso A, Golfieri R, Gramenzi A, Mazzaferro V, Mosconi C, Ponziani F, Sacco R, Trevisani F, Tarricone R. Trans-arterial radioembolization for intermediate-advanced hepatocellular carcinoma: a budget impact analysis. BMC Cancer 2018; 18:715. [PMID: 29976149 PMCID: PMC6034232 DOI: 10.1186/s12885-018-4636-7] [Citation(s) in RCA: 12] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/15/2017] [Accepted: 06/26/2018] [Indexed: 12/31/2022] Open
Abstract
Background Trans-arterial radio-embolization (TARE) is an emerging treatment for the management of hepatocellular carcinoma (HCC). TARE may compete with systemic chemotherapy, sorafenib, in intermediate stage patients with prior chemoembolization failure or advanced patients with tumoral macrovascular invasion with no extra-hepatic spread and good liver function. We performed a budget impact analysis (BIA) evaluating the expected changes in the expenditure for the Italian Healthcare Service within scenarios of increased utilization of TARE in place of sorafenib over the next five years. Methods Starting from patient level data from three oncology centres in Italy, a Markov model was developed to project on a lifetime horizon survivals and costs associated to matched cohorts of intermediate-advanced HCC patients treated with TARE or sorafenib. The initial model has been integrated with epidemiological data to perform a BIA comparing the current scenario with 20 and 80% utilization rates for TARE and sorafenib, respectively, with increasing utilization rates of TARE of 30, 40 and 50% over the next 1, 3 and 5 years. Results Compared to the current scenario, progressively increasing utilization rates of TARE over sorafenib in the next 5 years is expected to save globally about 7 million Euros. Conclusions Radioembolization can be considered a valuable treatment option for patients with intermediate-advanced HCC. These findings enrich the evidence about the economic sustainability of TARE in comparison to standard systemic chemotherapy within the context of a national healthcare service. Electronic supplementary material The online version of this article (10.1186/s12885-018-4636-7) contains supplementary material, which is available to authorized users.
Collapse
Affiliation(s)
- Carla Rognoni
- Centre for Research on Health and Social Care Management (CERGAS), SDA Bocconi School of Management, Via Roentgen 1, 20136, Milan, Italy.
| | - Oriana Ciani
- Centre for Research on Health and Social Care Management (CERGAS), SDA Bocconi School of Management, Via Roentgen 1, 20136, Milan, Italy.,Evidence synthesis and modelling for health improvement (ESMI), University of Exeter Medical School, South Cloisters St Luke's Campus Exeter, Exeter, UK
| | - Silvia Sommariva
- Centre for Research on Health and Social Care Management (CERGAS), SDA Bocconi School of Management, Via Roentgen 1, 20136, Milan, Italy.,College of Public Health, University of South Florida, Tampa, USA
| | - Irene Bargellini
- Azienda Ospedaliero-Universitaria Pisana, Via Roma 67, Pisa, Italy
| | - Sherrie Bhoori
- Department of Surgery, Liver Surgery, Transplantation and Gastroenterology, Istituto Nazionale Tumori Fondazione IRCCS, National Cancer Institute, Via G. Venezian 1, Milan, Italy
| | - Roberto Cioni
- Azienda Ospedaliero-Universitaria Pisana, Via Roma 67, Pisa, Italy
| | - Antonio Facciorusso
- Department of Surgery, Liver Surgery, Transplantation and Gastroenterology, Istituto Nazionale Tumori Fondazione IRCCS, National Cancer Institute, Via G. Venezian 1, Milan, Italy
| | - Rita Golfieri
- Azienda Ospedaliero-Universitaria di Bologna, Policlinico S.Orsola-Malpighi, Bologna, Italy
| | - Annagiulia Gramenzi
- Azienda Ospedaliero-Universitaria di Bologna, Policlinico S.Orsola-Malpighi, Bologna, Italy
| | - Vincenzo Mazzaferro
- Department of Surgery, Liver Surgery, Transplantation and Gastroenterology, Istituto Nazionale Tumori Fondazione IRCCS, National Cancer Institute, Via G. Venezian 1, Milan, Italy
| | - Cristina Mosconi
- Azienda Ospedaliero-Universitaria di Bologna, Policlinico S.Orsola-Malpighi, Bologna, Italy
| | - Francesca Ponziani
- Department of Surgery, Liver Surgery, Transplantation and Gastroenterology, Istituto Nazionale Tumori Fondazione IRCCS, National Cancer Institute, Via G. Venezian 1, Milan, Italy
| | - Rodolfo Sacco
- Azienda Ospedaliero-Universitaria Pisana, Via Roma 67, Pisa, Italy
| | - Franco Trevisani
- Azienda Ospedaliero-Universitaria di Bologna, Policlinico S.Orsola-Malpighi, Bologna, Italy
| | - Rosanna Tarricone
- Centre for Research on Health and Social Care Management (CERGAS), SDA Bocconi School of Management, Via Roentgen 1, 20136, Milan, Italy.,Department of Social and Political Sciences, Bocconi University, Via Roentgen 1, Milan, Italy
| |
Collapse
|
11
|
Lucà MG, Nani R, Schranz M, De Giorgio M, Iegri C, Agazzi R, Sala F, Virotta G, Sarti D, Conte G, Pinelli D, Nicora C, Colledan M, Sironi S, Fagiuoli S. Treatment of hepatocellular carcinoma: a cost analysis of yttrium-90 transarterial radioembolization versus sorafenib. Future Oncol 2018; 14:727-735. [DOI: 10.2217/fon-2017-0566] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/21/2022] Open
Abstract
Aim: The aim was to evaluate cost–effectiveness of yttrium-90 transarterial radioembolization (TARE) in comparison to sorafenib treatment. Patients & methods: A single-center, retrospective, observational study was performed, 166 patients with intermediate-/advanced-stage hepatocellular carcinoma were treated with sorafenib and 19 with TARE. The patients out of the sorafenib group matching the inclusion criteria for TARE, were reassigned to a subgroup SOR3. Results: Mean costs for SOR3 patients amounted to €27,992 per patient, instead for TARE treatment, mean expense per patient was €17,761 (p = 0.028). Overall survival was similar between the two groups, while midterm survival rates (p = 0.012) were significantly higher with TARE treatment. Conclusion: TARE causes significantly lower treatment costs than sorafenib with better outcome in midterm survival.
Collapse
Affiliation(s)
- Maria Grazia Lucà
- Gastroenterology 1 – Hepatology & Transplantology, ASST Papa Giovanni XXIII, Piazza OMS – Organizzazione Mondiale della Sanità 1, 24127 Bergamo, Italy
| | - Roberto Nani
- Department of Radiology, University Milano Bicocca, ASST Papa Giovanni XXIII, Piazza OMS – Organizzazione Mondiale della Sanità 1, 24127 Bergamo, Italy
| | - Melanie Schranz
- Gastroenterology 1 – Hepatology & Transplantology, ASST Papa Giovanni XXIII, Piazza OMS – Organizzazione Mondiale della Sanità 1, 24127 Bergamo, Italy
| | - Massimo De Giorgio
- Gastroenterology 1 – Hepatology & Transplantology, ASST Papa Giovanni XXIII, Piazza OMS – Organizzazione Mondiale della Sanità 1, 24127 Bergamo, Italy
| | - Claudia Iegri
- Gastroenterology 1 – Hepatology & Transplantology, ASST Papa Giovanni XXIII, Piazza OMS – Organizzazione Mondiale della Sanità 1, 24127 Bergamo, Italy
| | - Roberto Agazzi
- Department of Radiology, University Milano Bicocca, ASST Papa Giovanni XXIII, Piazza OMS – Organizzazione Mondiale della Sanità 1, 24127 Bergamo, Italy
| | - Francesco Sala
- Department of Radiology, University Milano Bicocca, ASST Papa Giovanni XXIII, Piazza OMS – Organizzazione Mondiale della Sanità 1, 24127 Bergamo, Italy
| | - Giorgio Virotta
- Nuclear Medicine, ASST Papa Giovanni XXIII, Piazza OMS – Organizzazione Mondiale della Sanità 1, 24127 Bergamo, Italy
| | - Donatella Sarti
- Onco-Hematology Department, Azienda Ospedaliera Ospedali Riuniti Marche Nord, via Lombroso 1, 61122 Pesaro, Italy
| | - Grazia Conte
- General Surgery 3 – Abdominal Transplantations, ASST Papa Giovanni XXIII, Piazza OMS – Organizzazione Mondiale della Sanità 1, 24127 Bergamo, Italy
| | - Domenico Pinelli
- General Surgery 3 – Abdominal Transplantations, ASST Papa Giovanni XXIII, Piazza OMS – Organizzazione Mondiale della Sanità 1, 24127 Bergamo, Italy
| | - Carlo Nicora
- General Management, ASST Papa Giovanni XXIII, Piazza OMS – Organizzazione Mondiale della Sanità 1, 24127 Bergamo, Italy
| | - Michele Colledan
- General Surgery 3 – Abdominal Transplantations, ASST Papa Giovanni XXIII, Piazza OMS – Organizzazione Mondiale della Sanità 1, 24127 Bergamo, Italy
| | - Sandro Sironi
- Department of Radiology, University Milano Bicocca, ASST Papa Giovanni XXIII, Piazza OMS – Organizzazione Mondiale della Sanità 1, 24127 Bergamo, Italy
| | - Stefano Fagiuoli
- Gastroenterology 1 – Hepatology & Transplantology, ASST Papa Giovanni XXIII, Piazza OMS – Organizzazione Mondiale della Sanità 1, 24127 Bergamo, Italy
| |
Collapse
|
12
|
Rognoni C, Ciani O, Sommariva S, Tarricone R. Real-World Data for the Evaluation of Transarterial Radioembolization versus Sorafenib in Hepatocellular Carcinoma: A Cost-Effectiveness Analysis. VALUE IN HEALTH : THE JOURNAL OF THE INTERNATIONAL SOCIETY FOR PHARMACOECONOMICS AND OUTCOMES RESEARCH 2017; 20:336-344. [PMID: 28292478 DOI: 10.1016/j.jval.2016.09.2397] [Citation(s) in RCA: 23] [Impact Index Per Article: 3.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 03/27/2016] [Revised: 08/07/2016] [Accepted: 09/12/2016] [Indexed: 06/06/2023]
Abstract
OBJECTIVES To perform a cost-effectiveness analysis comparing the use of transarterial radioembolization (TARE) with that of sorafenib in the treatment of patients with intermediate or advanced hepatocellular carcinoma (HCC) according to the Barcelona Clinic Liver Cancer staging system. METHODS Patient-level data were consecutively recorded and collected at three oncology centers in Italy. A propensity score matching was performed to compare patients with similar clinical characteristics who underwent TARE or sorafenib treatment. Clinical data from the matched cohorts were used to populate a Markov model to project, on a lifetime horizon, life years, quality-adjusted life years, and economic outcomes associated with TARE and sorafenib for both intermediate and advanced HCC stages. RESULTS Starting from data covering 389 and 241 patients who underwent TARE and sorafenib treatment, respectively, the propensity score matching yielded a total of 308 matched patients. For intermediate-stage patients, the model estimated for TARE versus sorafenib an incremental cost-utility ratio of €3,302/QALY (incremental cost-effectiveness ratio of €1,865 per life year gained), whereas for patients in advanced stage TARE dominated (lower costs and greater health improvements) compared with sorafenib. CONCLUSIONS From an Italian health care service perspective, TARE could be a cost-effective strategy in comparison with sorafenib for patients with intermediate or advanced HCC. The results from forthcoming randomized controlled trials comparing TARE with sorafenib will be able to confirm or reject the validity of this preliminary evaluation. In the meantime, decision makers can use these results to control and coordinate the diffusion of the technology.
Collapse
Affiliation(s)
- Carla Rognoni
- Centre for Research on Health and Social Care Management (CERGAS), Bocconi University, Milan, Italy.
| | - Oriana Ciani
- Centre for Research on Health and Social Care Management (CERGAS), Bocconi University, Milan, Italy; Evidence Synthesis and Modelling for Health Improvement (ESMI), University of Exeter Medical School, South Cloisters St Luke's Campus, Exeter, UK
| | - Silvia Sommariva
- Centre for Research on Health and Social Care Management (CERGAS), Bocconi University, Milan, Italy
| | - Rosanna Tarricone
- Centre for Research on Health and Social Care Management (CERGAS), Bocconi University, Milan, Italy; Department of Policy Analysis and Public Management, Bocconi University, Milan, Italy
| |
Collapse
|