Cost-effectiveness analysis of stereotactic body radiation therapy compared with surgery and radiofrequency ablation in two patient cohorts: metastatic liver cancer and hepatocellular carcinoma

Huajie Jin, Anastasia Chalkidou, Maria Hawkins, Jennifer Summers, Saskia Eddy, Janet Peacock, Bola Coker, James Good, Mark Pennington, SABR data working group

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Abstract

Purpose: To compare the cost-effectiveness of stereotactic body radiation therapy (SABR) with radiofrequency ablation (RFA) and surgery in adult patients with metastatic liver cancer and hepatocellular carcinoma (HCC).
Materials and methods: Two patient cohorts were assessed: liver oligometastases and HCC. For each patient cohort, a decision analytic model was constructed to assess the cost-effectiveness of interventions over a 5-year horizon. A Markov process was embedded in the decision model to simulate the possible prognosis of cancer. Data on transition probabilities, survival, side-effects, quality of life, and costs were obtained from published sources and the Commissioning through Evaluation (CtE) scheme. The primary outcome was the incremental cost-effectiveness ratio (ICER) with respect to quality adjusted life-years. The robustness of the results was examined in sensitivity analysis. Analyses were conducted from an NHS and Personal Social Services perspective.
Results: In the base case analysis, which assumes that all three interventions are associated with the same cancer progression rates and mortality rates, SABR is the most cost-effective intervention for both patient cohorts. This conclusion is sensitive to the cancer progression rate, mortality rate and cost of interventions. Assuming a willingness-to-pay threshold of £20,000 per QALY, the probability that SABR is cost-effective is 57% and 50% in liver oligometastases and HCC, respectively.
Conclusions: Our results indicate a potential for SABR to be cost-effective for patients with liver oligometastases and HCC. This finding supports further investigation in clinical trials directly comparing SABR with surgery and RFA.
Original languageEnglish
JournalClinical Oncology
Publication statusPublished - 17 Sept 2020

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