Recently presented pivotal trial data (Vilgrain et al. International Liver Congress 2017) has shown that there is no significant difference in overall survival between selective internal radiation therapy (SIRT) with Y-90 resin microspheres (SIR-Spheres®; Sirtex Medical, North Sydney, Australia) and sorafenib for patients with Barcelona Clinic Liver Cancer (BCLC) stage C liver-limited or liver-predominant hepatocellular carcinoma. Y-90 resin microspheres are, however, safer and better tolerated by patients than sorafenib, as well as reducing costs, due to single administration and less frequent and severe side effects. Our aim was to evaluate the cost effectiveness of SIRT using Y-90 resin microspheres versus sorafenib for the treatment of patients with BCLC stage C hepatocellular carcinoma in the UK.
A cost-minimisation model was built, with equal efficacy assumed between Y-90 resin microspheres and sorafenib. Adverse events data were collected from the Phase III SHARP trial for sorafenib (Llovet et al. N Engl J Med 2008;359:378–90) and from the ENRY study for Y-90 resin microspheres (Sangro et al. Hepatology 2011;54:868–78). Treatment costs were taken from standard UK sources and real-world data from a UK hospital; treatment and adverse events disutilities were taken from published literature. Inputs were validated by UK clinicians and one-way and probabilistic sensitivity analyses were performed.
SIRT using Y-90 resin microspheres is dominant versus sorafenib, providing greater quality-adjusted life years (QALYs) at a lower cost. Y-90 resin microspheres provide 0.0079 (95% confidence interval [CI] 0.0046–0.0111) more QALYs than sorafenib, while saving £8,909 (95% CI £3,257–£14,570). One-way sensitivity analysis showed time on treatment for sorafenib and the work-up and administration costs of Y-90 resin microspheres to be the parameters with the largest influence on results.
In the case of equal efficacy between Y-90 resin microspheres and sorafenib, SIRT using Y-90 resin microspheres is a cost-effective therapy for BCLC stage C hepatocellular carcinoma patients in the UK.
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BresMed Health Solutions Ltd
D. Palmer: Research grants, consultant, sponsored lectures: Sirtex and Bayer. P. Ross: Grants: Sanofi, consultant: Bayer, Celgene Sirtex, sponsored lectures: Bayer, Celgene, Merck, Roche. Travel and meeting attendance: Merck, Bayer, Celgene, Amgen and Servier. T. Shah: Grants: Novartis, and consulted Sirtex. D. Yu: Consultant: Bayer, Boston Scientific, Gore Medical, Sirtex and St Jude Medical. Lectures sponsored: Bayer, Boston Scientific, Gore Medical, Sirtex and St Jude Medical. S. Shergill: Employee of Sirtex. K. Patterson, N. Brereton, D. Lee: Reimbursed for work presented here by Sirtex