Cost-Effectiveness Analysis of Hepatic Arterial Chemotherapy for Advanced Hepatocellular Carcinoma in China: A Comparative Analysis of HAIC-FO and Sorafenib.

BACKGROUND The FOHAIC-1 trial showed hepatic arterial infusion chemotherapy with infusional fluorouracil, leucovorin, and oxaliplatin (HAIC-FO) improved survival, compared with sorafenib, in patients with advanced hepatocellular carcinoma (HCC). The aim of this study was to conduct a cost-effectiveness comparison between HAIC-FO and sorafenib from the perspective of the Chinese healthcare system. MATERIAL AND METHODS The economic evaluation was conducted between July 2023 and February 2024, spanning a 10-year investment horizon. A Markov model was developed to perform a cost-effectiveness analysis of HAIC-FO vs sorafenib. Health states incorporated in the model comprised progression-free disease, progressed disease, and death. Transition probabilities were derived from data obtained from the FOHAIC-1 trial. Incremental cost-effectiveness ratio (ICER) was calculated to evaluate cost-effectiveness. Additionally, one-way and probabilistic sensitivity analyses assessed the model's robustness. RESULTS The HAIC-FO group accrued a total cost of $22,781, whereas the sorafenib group totaled $18,795. In terms of effectiveness, the HAIC-FO group achieved 1.06 quality-adjusted life years (QALYs), whereas the sorafenib group attained 0.65 QALYs. Compared with sorafenib, HAIC-FO yielded an additional 0.41 QALYs at a cost of additional $3,985, resulting in an incremental cost of $9,720 per QALY gained. The one-way sensitivity analysis revealed the final ICER remained below the willingness-to-pay (WTP) threshold of $30,492 per QALY, when considering parameter fluctuations. Additionally, probabilistic sensitivity analysis indicated a 99.8% probability that the ICER for HAIC-FO compared with sorafenib would fall below the WTP threshold. CONCLUSIONS Compared with sorafenib, HAIC-FO emerged as a cost-effective first-line treatment option for patients facing advanced HCC in China.

Impact of continuous regional arterial infusion in the treatment of acute necrotizing pancreatitis: analysis of a national administrative database.

BACKGROUND: Although continuous regional arterial infusion (CRAI) of protease inhibitors and broad antibiotics has been suggested as one of the therapeutic option for patients with acute necrotic pancreatitis (ANP), the effectiveness has not been well-corroborated in clinical studies. METHODS: We conducted a retrospective cohort study using a Japanese national administrative database. Severe acute pancreatitis patients with a poorly enhanced pancreas region (i.e., definitive or clinically suspected ANP) were identified and dichotomized according to whether CRAI was performed. We compared the outcomes of in-hospital mortality, surgical interventions, hospital-free days, and healthcare costs between groups adjusted by the well-validated case-mix adjustment model using a multivariate mixed-effect regression analysis and a propensity score matching analysis. RESULTS: Of 243,312 acute pancreatitis patients, 702 eligible patients were identified, of these 339 patients underwent CRAI. The case-mix adjustment model established had good predictability for in-hospital mortality with an area under the receiver operating characteristics curve of 0.87. CRAI was significantly associated with reduced in-hospital mortality [14.5% in the CRAI group vs. 18.2% in the non-CRAI group, adjusted odds ratio (95% confidence interval; CI) = 0.60 (0.36-0.97)]. Significant associations were not observed for the frequency of surgical interventions and mean hospital-free days; however, significantly higher healthcare costs were observed in the CRAI group. Results of the propensity score matching analysis did not alter these results. CONCLUSIONS: Analysis of a nationwide large-scale database suggested that CRAI was significantly associated with reduced in-hospital mortality for patients with ANP. Further randomized controlled trials are warranted.

Net health benefit of hepatic resection versus intraarterial therapies for neuroendocrine liver metastases: A Markov decision model.

BACKGROUND: Management of patients with neuroendocrine liver metastasis (NELM) remains controversial. We sought to compare the net health benefit (NHB) of hepatic resection (HR) versus intraarterial therapy (IAT) among patients with NELM. METHODS: A decision analytic Markov model was created to estimate and compare the cost effectiveness associated with different management strategies (HR vs IAT) for a simulated cohort of patients with NELM. The primary (base case) analysis was calculated based on a 57-year-old male patient with metachronous, symptomatic NELM that involved <25% of the liver in the absence of extrahepatic disease. The endpoints were quality-adjusted life-months (QALMs), quality-adjusted life-year (QALY), incremental cost-effectiveness ratio (ICER), and NHB. RESULTS: In the base case analysis, HR was strongly favored over IAT providing NHB of 20.0 QALMs and an ICER of $8,427 per QALY. In the Monte Carlo simulation, the greatest NHB for HR was among patients with functioning/symptomatic NELM, regardless of liver tumor burden. In the symptomatic group, IAT was favored only in a minority of old patients (>60 years) with extrahepatic disease and synchronous NELM. In contrast, in patients with nonfunctioning/asymptomatic NELM, hepatic tumor burden was the most important variable and HR was always cost ineffective in large tumors, independent of patient age and extrahepatic disease characteristics. CONCLUSION: A Markov decision model demonstrated that HR was the preferred strategy among patients with symptomatic NELM, regardless of hepatic disease burden. In contrast, IAT should be preferred for patients with large volume nonfunctioning/asymptomatic NELM.

Using cost-effective intra-arterial chemotherapy to treat retinoblastoma in Chile.

Intra-arterial chemotherapy (IAC) has proved to be an effective treatment for retinoblastoma, but can be very expensive in developing countries. We report 2 patients from Chile in whom IAC resulted in globe salvation. Both patients had their medical care provided by the public health system and had failed standard therapy.

Cost analysis of intra-arterial versus intra-venous delivery of bevacizumab for the treatment of recurrent glioblastoma multiforme.

Intra-arterial bevacizumab (IA BV) has been recently identified to be safe in the treatment of recurrent GBM. In this study, we sought to perform a cost analysis of IA BV versus IV BV especially also taking account of patient progression free survival (PFS) and overall survival (OS). We show that IA BV is significantly more cost effective than conventional IV therapy.

[Financial analysis of intraarterial procedures in acute stroke]. / Análisis económico del intervencionismo en el ictus agudo.

INTRODUCTION: Since the most decisive factor related to the cost of stroke is disability, any acute phase intervention to reduce disability will probably be cost-effective. The present acute stroke phase analysis is the first cost-benefit study on intraarterial procedures in acute stroke phase. METHOD: Case-control study focusing on the cost of stroke including acute stroke patients subjected to interventionism in Hospital Virgen del Rocío in 2003-2004 was conducted. The data obtained was subsequently extrapolated to the number of patients who would have been treated if intraarterial procedures could be performed on a 24 hour-day basis. RESULTS: 32 patients were treated in 2003-2004. Direct cost (devices and human resources) of each treated patient was 10,502 euros and global saving in hospital stay and rehabilitation was 11,069 euros, resulting in 567 euros net saving per patient. Nevertheless, 92 patients would have been treated if intraarterial procedures could have been performed on a 24 hour-day basis, resulting in better financial results with 5,792 saving for each treated patient. CONCLUSIONS: Intracraneal procedures in acute stroke has been shown to be cost-effective since cost of material and human resources is greatly exceeded by the saving in hospitalization and rehabilitation as a result of reduction in patient disability.

Intrahepatic arterial versus intravenous fluorouracil and folinic acid for colorectal cancer liver metastases: a multicentre randomised trial.

BACKGROUND: The liver is the most frequent site for metastases of colorectal cancer, which is the second largest contributor to cancer deaths in Europe. We did a randomised trial to compare an intrahepatic arterial (IHA) fluorouracil and folinic acid regimen with the standard intravenous de Gramont fluorouracil and folinic acid regimen for patients with adenocarcinoma of the colon or rectum, with metastases confined to the liver. METHODS: We randomly allocated 290 patients from 16 centres to receive either intravenous chemotherapy (folinic acid 200 mg/m2, fluorouracil bolus 400 mg2 and 22-h infusion 600 mg/m2, day 1 and 2, repeated every 14 days), or IHA chemotherapy designed to be equitoxic (folinic acid 200 mg/m2, fluorouracil 400 mg/m2 over 15 mins and 22-h infusion 1600 mg/m2, day 1 and 2, repeated every 14 days). The primary endpoint was overall survival, and analysis was by intention to treat. FINDINGS: 50 (37%) patients allocated to IHA did not start their treatment, and another 39 (29%) had to stop before receiving six cycles of treatment because of catheter failure. The IHA group received a median of two cycles (0-6), compared with 8.5 (6-12) for the intravenous group. 45 (51%) IHA patients who did not start or did not receive six cycles switched to intravenous treatment. In both groups, grade 3 or 4 toxicity was uncommon. Median overall survival was 14.7 months for the IHA group and 14.8 months for the intravenous group (hazard ratio 1.04 [95% CI 0.80-1.33], log-rank test p=0.79). Similarly, there was no significant difference in progression-free survival. INTERPRETATION: Our results showed no evidence of an advantage in progression-free survival or overall survival for the IHA group; thus continued use of this regimen cannot be recommended outside of a clinical trial.

Intrahepatic arterial infusion of chemotherapy: clinical results.

Approximately 60% of patients diagnosed with colorectal cancer (CRC) will go on to develop hepatic metastases. Although surgical resection is the only curative modality, a majority will not be able to undergo surgery. Alternative methods for treating this population have focused on the feasibility of hepatic arterial infusion (HAI) of chemotherapy. Randomized data in this field have been hampered due to small numbers of patients in some trials, or crossover between groups. However, most trials have suggested an improvement in both overall and progression-free survival with HAI therapy. Dose-limiting toxicity associated with HAI is related to hepatobiliary sclerosis, which has been reduced with the use of dexamethasone as part of the treatment. Current research is underway to improve the rate of extrahepatic metastases in patients undergoing HAI.

Measuring "hang time": contamination of intra-arterial flush solutions over time.

This study reports on improved patient care through procedures that reduce the likelihood of hospital-acquired infections. This investigation found that longer "hang times" for nurse-prepared intra-arterial flush solutions did not significantly increase the patient's risk of infection. In addition, the article details cost savings and procedures to better manage nurses' time.

Hepatic-arterial chemotherapy.

The liver is a common site of metastases from cancers from most sites, but particularly from the gastrointestinal tract, since the portal vein drains into the liver. About half of all patients with colorectal cancer develop liver metastases. The response of liver metastases to systemic combination chemotherapy has improved, but the 2-year survival is only 25-30%. Hepatic-arterial infusion of chemotherapy produces higher response rates, with a 2-year survival of 50-60%. In patients who can undergo liver resection followed by hepatic-arterial infusion, the 2-year survival is 85%. This review summarises the anatomical basis, pharmacokinetic background, and cost-effectiveness of this procedure. We discuss the phase II and phase III studies of hepatic-arterial infusion therapy, with a focus on liver metastases from colorectal cancer.

Cost-effectiveness of systemic and regional chemotherapy for the treatment of patients with unresectable colorectal liver metastases.

BACKGROUND: Management of unresectable colorectal liver metastases (CLM) can be by regional (hepatic arterial infusion [HAI]) or systemic chemotherapy, or by symptom control alone. In this study the costs of each type of management were related to clinical outcome in 134 patients with CLM. METHODS: The costs (both in terms of health care and to society) and benefits (treatment-added survival and normal quality of life survival) of chemotherapy treatment of 85 patients (HAI with implanted pump: 51 patients; and systemic chemotherapy: 34 patients) were compared with those in 49 patients managed by symptom control only. RESULTS: HAI chemotherapy cost the most (Pound Sterling 18,263 per patient) and symptom control the least (Pound sterling 2136 per patient). When survival was included, HAI was the most cost-effective treatment (health care cost per life year gained with HAI vs. systemic chemotherapy: Pound Sterling 24,604; systemic chemotherapy vs. symptom control: Pound Sterling 32,788), but there was no difference with regard to health care cost per normal quality of life gained. Societal costs incurred by lost work time and welfare payments during illness were higher for HAI (Pound Sterling 12,897) than systemic chemotherapy (Pound Sterling 9143) or symptom control (Pound Sterling 8090) because HAI-treated patients lived longer and, although working longer and contributing more productivity to society, lost more work days than other patients. CONCLUSIONS: The least expensive management for CLM was symptom control, whereas systemic and HAI chemotherapies were equally cost-effective in producing added normal quality survival for health care resources expended. Although overall societal costs were higher for HAI than for either systemic chemotherapy or symptom control, the cost benefit was difficult to interpret because of uncertain attitudes regarding continued work during terminal illness.

Treatment for advanced hepatocellular carcinoma by transarterial chemotherapy using reservoirs or one-shot arterial chemotherapy.

A prospective trial was performed in patients with advanced hepatocellular carcinoma to assess the therapeutic efficacy of transcatheter arterial chemotherapy using implanted reservoirs (12 patients) or conventional transcatheter arterial chemotherapy (8 patients). Epirubicin at a dose of 40 mg/m2 was given every month in the former, while epirubicin at a dose of 60 mg/m2 was administered every 3 months in the latter. During the 6 months from the introduction of these therapies, hospitalized periods were shorter and total hospital costs were less in the reservoir group than in the conventional chemotherapy group (p < 0.05 and p < 0.01, respectively). Transcatheter arterial chemotherapy using implanted reservoirs can be carried out on a day-care basis and may be beneficial for the treatment of patients with advanced hepatocellular carcinoma.

[Hepatic metastases of colorectal cancers: intra-arterial chemotherapy. Value and indications]. / Métastases hépatiques des cancers colorectaux: chimiothérapies intra-artérielles. Intérêt et indications.

Intraarterial hepatic chemotherapy (IAHC) increases the tumoral exposure of the liver metastases to cytotoxic agents. IAHC may be used in case of non resectable and isolated liver metastases from colorectal origin. It gives a tumor response rate of about 50%. Seven phase III trials and a recent metaanalysis testing IAHC using FUDR demonstrated its superiority over systemic chemotherapy using FUDR or bolus 5FU in terms of response rate and an increase in survival compared to symptomatic treatment. IAHC drawbacks are the biliary toxicity observed with some protocols, the development of extrahepatic metastasis and its cost. The ongoing protocols aim to improve the IAHC efficacy and tolerance and are frequently associated to systemic chemotherapy. The discovery of new active products in colorectal cancer and the optimisations of combinations of 5FU and leucovorin in terms of efficacy stimulate research aimed at developing more active combinations of IAHC and active systemic chemotherapy. The best IAHC indications are presently unresectable hepatic metastases from colorectal cancer without extra-hépatic metastases, with less than 50% liver involvement, with a CEA level under 100 ng/ml.

[A modified technic for local rt-PA catheter-mediated lysis]. / Modifizierte Technik der lokalen rt-PA-Katheterlyse.

PURPOSE: To develop an economic and efficient concept for more time-saving local rt-PA thrombolysis therapy. METHOD: 40 patients with peripheral vascular occlusive disease stage IIb-III according to the Fontaine classification and with angiographically proven occluded segments of pelvic and lower limb arteries were treated by a modified concept of local rt-PA catheter thrombolysis. Via a thin guide wire the catheter for thrombolysis is slowly advanced through the thrombus without fluoroscopic control, outside the room in which angiography is performed. In 24 cases a short-term lysis and in 16 cases a long-term lysis was carried out. RESULTS: The initial success rate was 75%, the patency rate in six months' follow-up was 66.7%. The ankle-brachial index decreased from 0.4 +/- 0.3 to 0.8 +/- 0.2 on the average. There were no relevant clinical complications. The average occupancy time of the angiography room or table was 60 +/- 52 min, the average time of fluoroscopy was 17 +/- 13 min. CONCLUSION: In modified local rt-PA thrombolysis, short-term lysis and long-term lysis were mostly performed outside the angiography room, so that the exposure to radiation and there fore the radiation dose were reduced for both the patient and the attending staff. The angiography room is thus available for other patients and can therefore be used more efficiently.