Cost-effectiveness analysis of stereotactic body radiotherapy versus transarterial chemoembolization for unresectable hepatocellular carcinoma: An economic evaluation from a payer's perspective

Hepatocellular carcinoma is the sixth most common cancer worldwide and the leading cause of death among patients with cirrhosis. The vast majority of these patients have the unresectable, intermediate-stage form of the disease, for which the standard of care is transarterial chemoembolization. With the health care sector rapidly outgrowing the national economy, maximizing value is now a major priority in health policy, especially with regard to cancer. Recent evidence suggests that stereotactic body radiotherapy may be a viable alternative to transarterial chemoembolization among patients of in early or very early stage of carcinoma. This evidence warrants a cost-effectiveness analysis, which not been conducted to date; the results of this study may directly impact practice guidelines for this disease. A Markov decision model was used to model the clinical trajectory of a typical patient with unresectable hepatocellular carcinoma. Costs were derived from a combination of previous studies and economic outcomes data. We hypothesized that stereotactic body radiotherapy achieves significantly greater cost-effectiveness than the current standard of care for hepatocellular carcinoma but we found the opposite may be in fact true and that transarterial chemoembolization may a more efficient management strategy for typical patients with unresectable hepatocellular carcinoma