An economic analysis presented by Laura Crocetti (University of Pisa, Pisa, Italy) in collaboration with several Italian centres including the Bocconi University, University of Bologna, University of Turin, Istituto Nazionale Tumori–Milan, and Presidio Ospedaliero Universitario–Udine, has found that transarterial radioembolization (TARE) with yttrium-90 (Y-90) glass microspheres with both standard and personalised dosimetry is a more cost-effective treatment option than transarterial chemoembolization (TACE) in patients with early- and intermediate-stage hepatocellular carcinoma (HCC) who are not eligible for surgery or ablation.
The analysis was presented at the Cardiovascular and Interventional Radiological Society of Europe (CIRSE) annual congress (13–17 September, Barcelona, Spain) during a first-release data session.
The study applied a micro-costing approach, which is considered a precise method of calculating hospital expenditure, to capture the cost of the full patient pathway, Crocetti explained. This included first-line treatment, re-embolization, complication management, follow-up visits, imaging, laboratory testing, and first subsequent therapy at progression. Data were derived from the TRACE randomised controlled trial led by Elisabeth Dhondt (Ghent University, Belgium) et al, which compared radioembolization with TACE, and included a scenario analysis to test robustness across different European healthcare settings.
Crocetti indicated that longer survival among Y-90-treated patients resulted in higher overall treatment costs due initial cost of treatment and to longer follow-up, but this cost is distributed in a higher number of living patients and was offset by fewer early retreatments, a longer duration of response, and reduced adverse event burden. When adjusted for life-years gained, Crocetti detailed that treatment with Y-90 generated savings of €800 per life-year with standard dosimetry and €2,700 with personalised dosimetry compared with TACE.
The speaker went on to describe incremental net monetary benefit (INMB), which translates health gains into economic value, stating that this value was positive for both approaches, particularly when using personalised dosimetry. “To make things very easy,” Crocetti said, “if the INMB is positive, it indicates that the new treatment under evaluation is cost-effective. As you can see, both standard dosimetry and personalised dosimetry had a very positive INMB.”
Crocetti then addressed their analysis’ generalisability, explaining that their scenario analyses across European countries with different healthcare cost structures yielded consistently positive INMB values.
“The investigators chose two different countries from the lowest to the highest cost levels, and the model demonstrated consistently positive INMB values by country, and this is confirmation of what we have already seen in the literature regarding the cost-effectiveness of Y-90 when compared with TACE,” she said.
Summarising the findings, the presenter reported that radioembolization with glass microspheres offered improved survival over two years compared with TACE, with a lower cost-per-life-year and positive INMB values. The results, Crocetti announced, have been accepted for publication in the journal CardioVascular and Interventional Radiology (CVIR). Crocetti emphasised that reimbursement remains a key hurdle in Italy and other European countries, and that these findings will be used to support wider access to Y-90 treatment.
Session moderator Stephen Kee, interventional radiologist and executive vice president of Syncromune, noted that the results, in a nutshell, demonstrate that: “If you live longer, it costs more. But the cost-per-year goes down, and that is superb,” he said. “It may not change how we practice, but it’ll influence the people who make decisions about us.”
