Nuclear Medicine Department, Hospital Gregorio Marañón, Madrid, Spain.
Nuclear Medicine Department, Hospital Clínico Universitario, Valencia, Spain.
BMC Gastroenterol. 2023 May 24;23(1):181. doi: 10.1186/s12876-023-02793-5.
Transarterial radioembolization with yttrium-90 (Y-90 TARE) microspheres therapy has demonstrated positive clinical benefits for the treatment of liver metastases from colorectal cancer (lmCRC). This study aims to conduct a systematic review of the available economic evaluations of Y-90 TARE for lmCRC.
English and Spanish publications were identified from PubMed, Embase, Cochrane, MEDES health technology assessment agencies, and scientific congress databases published up to May 2021. The inclusion criteria considered only economic evaluations; thus, other types of studies were excluded. Purchasing-power-parity exchange rates for the year 2020 ($US PPP) were applied for cost harmonisation.
From 423 records screened, seven economic evaluations (2 cost-analyses [CA] and 5 cost-utility-analyses [CUA]) were included (6 European and 1 USA). All included studies (n = 7) were evaluated from a payer and the social perspective (n = 1). Included studies evaluated patients with unresectable liver-predominant metastases of CRC, refractory to chemotherapy (n = 6), or chemotherapy-naïve (n = 1). Y-90 TARE was compared to best supportive care (BSC) (n = 4), an association of folinic acid, fluorouracil and oxaliplatin (FOLFOX) (n = 1), and hepatic artery infusion (HAI) (n = 2). Y-90 TARE increased life-years gained (LYG) versus BSC (1.12 and 1.35 LYG) and versus HAI (0.37 LYG). Y-90 TARE increased the quality-adjusted-life-year (QALY) versus BSC (0.81 and 0.83 QALY) and versus HAI (0.35 QALY). When considering a lifetime horizon, Y-90 TARE reported incremental cost compared to BSC (range 19,225 to 25,320 $US PPP) and versus HAI (14,307 $US PPP). Y-90 TARE reported incremental cost-utility ratios (ICURs) between 23,875 $US PPP/QALY to 31,185 $US PPP/QALY. The probability of Y-90 TARE being cost-effective at £ 30,000/QALY threshold was between 56% and 57%.
Our review highlights that Y-90 TARE could be a cost-effective therapy either as a monotherapy or when combined with systemic therapy for treating ImCRC. However, despite the current clinical evidence on Y-90 TARE in the treatment of ImCRC, the global economic evaluation reported for Y-90 TARE in ImCRC is limited (n = 7), therefore, we recommend future economic evaluations on Y-90 TARE versus alternative options in treating ImCRC from the societal perspective.
钇-90（Y-90）放射性栓塞微球疗法（TARE）已被证明对治疗结直肠癌肝转移（lmCRC）具有积极的临床益处。本研究旨在对 Y-90 TARE 治疗 lmCRC 的现有经济评估进行系统回顾。
从 PubMed、Embase、Cochrane、MEDES 健康技术评估机构和科学大会数据库中检索到截至 2021 年 5 月发表的英文和西班牙文文献。纳入标准仅考虑经济评估；因此，排除了其他类型的研究。应用 2020 年的购买力平价换算率（$US PPP）进行成本协调。
从 423 篇筛选的记录中，纳入了 7 项经济评估（2 项成本分析[CA]和 5 项成本效益分析[CUA]）（6 项欧洲研究和 1 项美国研究）。所有纳入的研究（n=7）均从支付者和社会角度进行了评估（n=1）。纳入的研究评估了无法切除的以肝脏为主的结直肠癌转移灶、对化疗耐药（n=6）或化疗初治（n=1）的患者。Y-90 TARE 与最佳支持治疗（BSC）（n=4）、亚叶酸、氟尿嘧啶和奥沙利铂（FOLFOX）（n=1）和肝动脉输注（HAI）（n=2）进行了比较。Y-90 TARE 与 BSC 相比增加了获得的生命年（LYG）（1.12 和 1.35 LYG）和与 HAI 相比增加了 LYG（0.37 LYG）。Y-90 TARE 与 BSC 相比增加了质量调整生命年（QALY）（0.81 和 0.83 QALY）和与 HAI 相比增加了 QALY（0.35 QALY）。在考虑终身时间范围时，Y-90 TARE 与 BSC 相比报告了增量成本（范围为 19225 至 25320 $US PPP）和与 HAI 相比报告了增量成本（14307 $US PPP）。Y-90 TARE 报告的增量成本-效益比（ICUR）在 23875 $US PPP/QALY 至 31185 $US PPP/QALY 之间。Y-90 TARE 在 30000 英镑/QALY 阈值下具有成本效益的概率在 56%至 57%之间。
我们的综述强调，Y-90 TARE 作为单一疗法或与系统疗法联合用于治疗 lmCRC 时，可能是一种具有成本效益的治疗方法。然而，尽管目前有关于 Y-90 TARE 在 lmCRC 治疗中的临床证据，但 Y-90 TARE 在 lmCRC 中的全球经济评估报告有限（n=7），因此，我们建议从社会角度对 Y-90 TARE 与治疗 lmCRC 的替代方案进行未来的经济评估。
