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

Abstract

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.

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