RESUMEN
AIM: We evaluated two treatment sequences, transarterial radioembolization followed by transarterial chemoembolization and possibly sorafenib (=TTS) versus transarterial radioembolization followed by sorafenib alone (=TS), to identify the most cost-effective pathway to treat intermediate-stage hepatocellular carcinoma from the Italian healthcare system perspective. MATERIALS & METHODS: A Markov model was developed to project costs and health outcomes for TTS and TS over a lifetime horizon. Data available at three hospitals in Italy were collected. Healthcare resource utilization was derived from standard clinical protocols. Costs were obtained from official regional tariffs. RESULTS & CONCLUSION: Taking into consideration 16 patients for TTS and 22 patients for TS pathways, the TTS sequence provided a dominant strategy in comparison to TS. Further evidence is desirable to confirm these results.
Asunto(s)
Carcinoma Hepatocelular/terapia , Quimioembolización Terapéutica/métodos , Neoplasias Hepáticas/terapia , Sorafenib/uso terapéutico , Anciano , Antineoplásicos/economía , Antineoplásicos/uso terapéutico , Carcinoma Hepatocelular/economía , Quimioembolización Terapéutica/economía , Terapia Combinada/economía , Terapia Combinada/métodos , Análisis Costo-Beneficio , Costos de los Medicamentos , Recursos en Salud/economía , Recursos en Salud/estadística & datos numéricos , Hospitalización/economía , Humanos , Italia , Neoplasias Hepáticas/economía , Cadenas de Markov , Calidad de Vida , Años de Vida Ajustados por Calidad de Vida , Sorafenib/economía , Resultado del TratamientoRESUMEN
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.
Asunto(s)
Antineoplásicos/economía , Antineoplásicos/uso terapéutico , Carcinoma Hepatocelular/terapia , Embolización Terapéutica/economía , Neoplasias Hepáticas/terapia , Niacinamida/análogos & derivados , Compuestos de Fenilurea/economía , Compuestos de Fenilurea/uso terapéutico , Anciano , Instituciones Oncológicas , Carcinoma Hepatocelular/patología , Estudios de Cohortes , Análisis Costo-Beneficio , Embolización Terapéutica/métodos , Femenino , Humanos , Italia , Estimación de Kaplan-Meier , Neoplasias Hepáticas/patología , Masculino , Cadenas de Markov , Persona de Mediana Edad , Estadificación de Neoplasias , Niacinamida/economía , Niacinamida/uso terapéutico , Años de Vida Ajustados por Calidad de Vida , Sorafenib , SobrevidaRESUMEN
BACKGROUND AND OBJECTIVE: Non-valvular atrial fibrillation (NVAF) increases the risk of systemic thromboembolic events; therefore, anticoagulant treatment with vitamin K antagonists is widely prescribed. Recently, new oral anticoagulants (NOAs) directly inhibiting thrombin (dabigatran) or factor Xa (rivaroxaban and apixaban) demonstrated their non-inferiority with respect to warfarin in reducing the thromboembolic risk. The aim of this study was to estimate the cost effectiveness of NOAs in an Italian setting. METHODS: A Markov decision model including ten health states and death was developed, and a 3-month Markov cycle and lifetime horizon were adopted. Transition probabilities and quality of life were estimated from three randomized trials and from additional reports in the literature. Analysis was performed in the context of the Italian National Health System. First- and second-order sensitivity analyses were made to test the robustness of the results. The mean European cost of dabigatran (