IDEAS home Printed from https://ideas.repec.org/a/plo/pone00/0185198.html
   My bibliography  Save this article

Cost-effectiveness analysis of treatment with non-curative or palliative intent for hepatocellular carcinoma in the real-world setting

Author

Listed:
  • Hla-Hla Thein
  • Yao Qiao
  • Ahmad Zaheen
  • Nathaniel Jembere
  • Gonzalo Sapisochin
  • Kelvin K W Chan
  • Eric M Yoshida
  • Craig C Earle

Abstract

Hepatocellular carcinoma (HCC) presentation is heterogeneous necessitating a variety of therapeutic interventions with varying efficacies and associated prognoses. Poor prognostic patients often undergo non-curative palliative interventions including transarterial chemoembolization (TACE), sorafenib, chemotherapy, or purely supportive care. The decision to pursue one of many palliative interventions for HCC is complex and an economic evaluation comparing these interventions has not been done. This study evaluates the cost-effectiveness of non-curative palliative treatment strategies such as TACE alone or TACE+sorafenib, sorafenib alone, and non-sorafenib chemotherapy compared with no treatment or best supportive care (BSC) among patients diagnosed with HCC between 2007 and 2010 in a Canadian setting. Using person-level data, we estimated effectiveness in life years and quality-adjusted life years (QALYs) along with total health care costs (2013 US dollars) from the health care payer’s perspective (3% annual discount). A net benefit regression approach accounting for baseline covariates with propensity score adjustment was used to calculate incremental net benefit to generate incremental cost-effectiveness ratio (ICER) and uncertainty measures. Among 1,172 identified patients diagnosed with HCC, 4.5%, 7.9%, and 5.6%, received TACE alone or TACE+sorafenib, sorafenib, and non-sorafenib chemotherapy clone, respectively. Compared with no treatment or BSC (81.9%), ICER estimates for TACE alone or TACE+sorafenib was $6,665/QALY (additional QALY: 0.47, additional cost: $3,120; 95% CI: -$18,800-$34,500/QALY). The cost-effectiveness acceptability curve demonstrated that if the relevant threshold was $50,000/QALY, TACE alone or TACE+sorafenib, non-sorafenib chemotherapy, and sorafenib alone, would have a cost-effectiveness probability of 99.7%, 46.6%, and 5.5%, respectively. Covariates associated with the incremental net benefit of treatments are age, sex, comorbidity, and cancer stage. Findings suggest that TACE with or without sorafenib is currently the most cost-effective active non-curative palliative treatment approach to HCC. Further research into new combination treatment strategies that afford the best tumor response is needed.

Suggested Citation

  • Hla-Hla Thein & Yao Qiao & Ahmad Zaheen & Nathaniel Jembere & Gonzalo Sapisochin & Kelvin K W Chan & Eric M Yoshida & Craig C Earle, 2017. "Cost-effectiveness analysis of treatment with non-curative or palliative intent for hepatocellular carcinoma in the real-world setting," PLOS ONE, Public Library of Science, vol. 12(10), pages 1-20, October.
    • Handle: RePEc:plo:pone00:0185198
    DOI: 10.1371/journal.pone.0185198
    as

    Download full text from publisher

    File URL: https://journals.plos.org/plosone/article?id=10.1371/journal.pone.0185198
    Download Restriction: no
    File URL: https://journals.plos.org/plosone/article/file?id=10.1371/journal.pone.0185198&type=printable
    Download Restriction: no
    File URL: https://libkey.io/10.1371/journal.pone.0185198?utm_source=ideas
    LibKey link: if access is restricted and if your library uses this service, LibKey will redirect you to where you can use your library subscription to access this item
    ---><---

    References listed on IDEAS

    as
    1. Nathaniel Jembere & Michael A Campitelli & Morris Sherman & Jordan J Feld & Wendy Lou & Stuart Peacock & Eric Yoshida & Murray D Krahn & Craig Earle & Hla-Hla Thein, 2012. "Influence of Socioeconomic Status on Survival of Hepatocellular Carcinoma in the Ontario Population; A Population-Based Study, 1990–2009," PLOS ONE, Public Library of Science, vol. 7(7), pages 1-10, July.
    2. Leida Zhang & Peng Hu & Xi Chen & Ping Bie, 2014. "Transarterial Chemoembolization (TACE) plus Sorafenib Versus TACE for Intermediate or Advanced Stage Hepatocellular Carcinoma: A Meta-Analysis," PLOS ONE, Public Library of Science, vol. 9(6), pages 1-8, June.
    3. Songlin Peng & Yang Zhao & Feng Xu & Changjun Jia & Yongqing Xu & Chaoliu Dai, 2014. "An Updated Meta-Analysis of Randomized Controlled Trials Assessing the Effect of Sorafenib in Advanced Hepatocellular Carcinoma," PLOS ONE, Public Library of Science, vol. 9(12), pages 1-13, December.
    4. David J. McLernon & John Dillon & Peter T. Donnan, 2008. "Systematic Review: Health-State Utilities in Liver Disease: A Systematic Review," Medical Decision Making, , vol. 28(4), pages 582-592, July.
    5. Jeffrey S. Hoch & Andrew H. Briggs & Andrew R. Willan, 2002. "Something old, something new, something borrowed, something blue: a framework for the marriage of health econometrics and cost‐effectiveness analysis," Health Economics, John Wiley & Sons, Ltd., vol. 11(5), pages 415-430, July.
    6. Joanna Siegel & George Torrance & Louise Russell & Bryan Luce & Milton Weinstein & Marthe Gold, 1997. "Guidelines for Pharmacoeconomic Studies," PharmacoEconomics, Springer, vol. 11(2), pages 159-168, February.
    Full references (including those not matched with items on IDEAS)

    Citations

    Citations are extracted by the CitEc Project, subscribe to its RSS feed for this item.
    as


    Cited by:

    1. Elizabeth Parody-Rúa & Maria Rubio-Valera & César Guevara-Cuellar & Ainhoa Gómez-Lumbreras & Marc Casajuana-Closas & Cristina Carbonell-Duacastella & Ignacio Aznar-Lou, 2020. "Economic Evaluations Informed Exclusively by Real World Data: A Systematic Review," IJERPH, MDPI, vol. 17(4), pages 1-18, February.

    Most related items

    These are the items that most often cite the same works as this one and are cited by the same works as this one.
    1. Noemi Kreif & Richard Grieve & Rosalba Radice & Zia Sadique & Roland Ramsahai & Jasjeet S. Sekhon, 2012. "Methods for Estimating Subgroup Effects in Cost-Effectiveness Analyses That Use Observational Data," Medical Decision Making, , vol. 32(6), pages 750-763, November.
    2. Mohamed N.M.T. Al Khayat & Job F.H. Eijsink & Maarten J. Postma & Jan C. Wilschut & Marinus van Hulst, 2020. "The Cost-Effectiveness of Hepatitis C Virus Screening Strategies among Recently Arrived Migrants in the Netherlands," IJERPH, MDPI, vol. 17(17), pages 1-13, August.
    3. Noémi Kreif & Richard Grieve & M. Zia Sadique, 2013. "Statistical Methods For Cost‐Effectiveness Analyses That Use Observational Data: A Critical Appraisal Tool And Review Of Current Practice," Health Economics, John Wiley & Sons, Ltd., vol. 22(4), pages 486-500, April.
    4. Konstantinos Katsanos & Panagiotis Kitrou & Stavros Spiliopoulos & Ioannis Maroulis & Theodore Petsas & Dimitris Karnabatidis, 2017. "Comparative effectiveness of different transarterial embolization therapies alone or in combination with local ablative or adjuvant systemic treatments for unresectable hepatocellular carcinoma: A net," PLOS ONE, Public Library of Science, vol. 12(9), pages 1-31, September.
    5. Qi Cao & Erik Buskens & Hans L. Hillege & Tiny Jaarsma & Maarten Postma & Douwe Postmus, 2019. "Stratified treatment recommendation or one-size-fits-all? A health economic insight based on graphical exploration," The European Journal of Health Economics, Springer;Deutsche Gesellschaft für Gesundheitsökonomie (DGGÖ), vol. 20(3), pages 475-482, April.
    6. Abualbishr Alshreef & Allan J. Wailoo & Steven R. Brown & James P. Tiernan & Angus J. M. Watson & Katie Biggs & Mike Bradburn & Daniel Hind, 2017. "Cost-Effectiveness of Haemorrhoidal Artery Ligation versus Rubber Band Ligation for the Treatment of Grade II–III Haemorrhoids: Analysis Using Evidence from the HubBLe Trial," PharmacoEconomics - Open, Springer, vol. 1(3), pages 175-184, September.
    7. Jasjeet Singh Sekhon & Richard D. Grieve, 2012. "A matching method for improving covariate balance in cost‐effectiveness analyses," Health Economics, John Wiley & Sons, Ltd., vol. 21(6), pages 695-714, June.
    8. Andrea Manca & Neil Hawkins & Mark J. Sculpher, 2005. "Estimating mean QALYs in trial‐based cost‐effectiveness analysis: the importance of controlling for baseline utility," Health Economics, John Wiley & Sons, Ltd., vol. 14(5), pages 487-496, May.
    9. A. Gafni & S. D. Walter & S. Birch & P. Sendi, 2008. "An opportunity cost approach to sample size calculation in cost‐effectiveness analysis," Health Economics, John Wiley & Sons, Ltd., vol. 17(1), pages 99-107, January.
    10. Richard Grieve & Richard Nixon & Simon G. Thompson & Charles Normand, 2005. "Using multilevel models for assessing the variability of multinational resource use and cost data," Health Economics, John Wiley & Sons, Ltd., vol. 14(2), pages 185-196, February.
    11. Gemma E. Shields & Mark Wilberforce & Paul Clarkson & Tracey Farragher & Arpana Verma & Linda M. Davies, 2022. "Factors Limiting Subgroup Analysis in Cost-Effectiveness Analysis and a Call for Transparency," PharmacoEconomics, Springer, vol. 40(2), pages 149-156, February.
    12. Bärnighausen, Till & Bloom, David E., 2009. ""Conditional scholarships" for HIV/AIDS health workers: Educating and retaining the workforce to provide antiretroviral treatment in sub-Saharan Africa," Social Science & Medicine, Elsevier, vol. 68(3), pages 544-551, February.
    13. Shan Liu & Michaël Schwarzinger & Fabrice Carrat & Jeremy D Goldhaber-Fiebert, 2011. "Cost Effectiveness of Fibrosis Assessment Prior to Treatment for Chronic Hepatitis C Patients," PLOS ONE, Public Library of Science, vol. 6(12), pages 1-14, December.
    14. Constanza L Vargas & Manuel A Espinoza & Andrés Giglio & Alejandro Soza, 2015. "Cost Effectiveness of Daclatasvir/Asunaprevir Versus Peginterferon/Ribavirin and Protease Inhibitors for the Treatment of Hepatitis c Genotype 1b Naïve Patients in Chile," PLOS ONE, Public Library of Science, vol. 10(11), pages 1-16, November.
    15. Job F. H. Eijsink & Mohamed N. M. T. Al Khayat & Cornelis Boersma & Peter G. J. Horst & Jan C. Wilschut & Maarten J. Postma, 2021. "Cost-effectiveness of hepatitis C virus screening, and subsequent monitoring or treatment among pregnant women in the Netherlands," The European Journal of Health Economics, Springer;Deutsche Gesellschaft für Gesundheitsökonomie (DGGÖ), vol. 22(1), pages 75-88, February.
    16. John Hutton, 2012. "‘Health Economics’ and the evolution of economic evaluation of health technologies," Health Economics, John Wiley & Sons, Ltd., vol. 21(1), pages 13-18, January.
    17. Christian Brettschneider & Sebastian Kohlmann & Benjamin Gierk & Bernd Löwe & Hans-Helmut König, 2017. "Depression screening with patient-targeted feedback in cardiology: The cost-effectiveness of DEPSCREEN-INFO," PLOS ONE, Public Library of Science, vol. 12(8), pages 1-15, August.
    18. Claudia Schulz & Gisela Büchele & Raphael S. Peter & Dietrich Rothenbacher & Christian Brettschneider & Ulrich C. Liener & Clemens Becker & Kilian Rapp & Hans-Helmut König, 2021. "Health-economic evaluation of collaborative orthogeriatric care for patients with a hip fracture in Germany: a retrospective cohort study using health and long-term care insurance claims data," The European Journal of Health Economics, Springer;Deutsche Gesellschaft für Gesundheitsökonomie (DGGÖ), vol. 22(6), pages 873-885, August.
    19. Mehdi Javanbakht & Jesse Fishman & Eoin Moloney & Peter Rydqvist & Amir Ansaripour, 2023. "Early Cost-Effectiveness and Price Threshold Analyses of Resmetirom: An Investigational Treatment for Management of Nonalcoholic Steatohepatitis," PharmacoEconomics - Open, Springer, vol. 7(1), pages 93-110, January.
    20. Yu-Wen Wen & Yi-Wen Tsai & David Bin-Chia Wu & Pei-Fen Chen, 2013. "The Impact of Outliers on Net-Benefit Regression Model in Cost-Effectiveness Analysis," PLOS ONE, Public Library of Science, vol. 8(6), pages 1-9, June.

    More about this item

    Statistics

    Access and download statistics

    Corrections

    All material on this site has been provided by the respective publishers and authors. You can help correct errors and omissions. When requesting a correction, please mention this item's handle: RePEc:plo:pone00:0185198. See general information about how to correct material in RePEc.

    If you have authored this item and are not yet registered with RePEc, we encourage you to do it here. This allows to link your profile to this item. It also allows you to accept potential citations to this item that we are uncertain about.

    If CitEc recognized a bibliographic reference but did not link an item in RePEc to it, you can help with this form .

    If you know of missing items citing this one, you can help us creating those links by adding the relevant references in the same way as above, for each refering item. If you are a registered author of this item, you may also want to check the "citations" tab in your RePEc Author Service profile, as there may be some citations waiting for confirmation.

    For technical questions regarding this item, or to correct its authors, title, abstract, bibliographic or download information, contact: plosone (email available below). General contact details of provider: https://journals.plos.org/plosone/ .

    Please note that corrections may take a couple of weeks to filter through the various RePEc services.

    IDEAS is a RePEc service. RePEc uses bibliographic data supplied by the respective publishers.