SIR-Spheres Y-90 Resin Microspheres Versus Best Supportive Care in the Treatment of Unresectable Metastatic Colorectal Cancer Refractory to Chemotherapy: A Cost-Utility Analysis in the UK
Author(s)
Brennan VK1, Colaone F1, Shergill S1, Pollock RF2
1SIRTEX Medical United Kingdom Ltd, London, UK, 2Covalence Research Ltd., London, LON, UK
OBJECTIVES Treatment options for chemotherapy refractory metastatic colorectal cancer (mCRC) are relatively limited. Third-line systemic therapy options are currently restricted to regorafenib and TAS-102 (trifluridine/tipiracil), with selective internal radiation therapy (SIRT) providing another option for patients with liver dominant or liver limited metastases. The objective of the present analysis was to evaluate the cost-utility of SIRT with SIR-Spheres Y-90 resin microspheres relative to best supportive care (BSC) in the treatment of chemotherapy refractory mCRC from the perspective of the UK national healthcare payer. METHODS A cost-utility model was developed, utilizing a three-state Markov model structure to capture the progression of mCRC from progression-free survival to post-progression survival and death, informed by data from a retrospective cohort study of 224 patients with chemotherapy refractory mCRC. UK-specific unit costs were obtained from the literature, the British National Formulary, and National Health Service (NHS) England reference costs. Future costs and effects were discounted at 3.5% per annum over a lifetime time horizon. Probabilistic sensitivity analysis (PSA) and one-way sensitivity analyses were conducted, including an analysis in which SIRT work-up and procedure were conducted the same day with transradial access. RESULTS In the base case analysis, SIR-Spheres Y-90 resin microspheres resulted in an increase of 0.81 quality-adjusted life years (QALYs) from 0.69 QALYs with BSC to 1.50 QALYs. The improvement was accompanied by an increase in cost from £15,268 to £34,168, resulting in an incremental cost-utility ratio (ICUR) of £23,435 per QALY gained. With same-day transradial procedures, the ICUR decreased to £20,841. PSA reported a 96% likelihood of SIR-Spheres Y-90 resin microspheres being cost-effective versus BSC at a willingness-to-pay threshold of £50,000 per QALY gained. CONCLUSIONS SIR-Spheres Y-90 resin microspheres are a cost-effective treatment option compared to BSC for patients with liver-dominant colorectal metastases from the perspective of a UK national healthcare payer.
Conference/Value in Health Info
2020-11, ISPOR Europe 2020, Milan, Italy
Value in Health, Volume 23, Issue S2 (December 2020)
Code
PCN51
Topic
Economic Evaluation
Topic Subcategory
Cost-comparison, Effectiveness, Utility, Benefit Analysis
Disease
Oncology