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Cost-effectiveness of Hepatic Arterial Chemoembolization for Colorectal Liver Metastases Refractory to Systemic Chemotherapy¹

¹ From the Harvard Medical School, Boston, Mass (R.G.A., M.P.R., L.J.P., D.P.B., K.E.S.) and the Department of Radiology, Beth Israel Deaconess Medical Center, 330 Brookline Ave, Boston, MA 02215 (M.P.R., L.J.P., D.P.B., S.L.R., K.E.S.). From the 1999 RSNA scientific assembly. Received August 23, 1999; revision requested October 26; revision received November 23; accepted December 21. Address correspondence to M.P.R. (e-mail: mrosen2@caregroup.harvard.edu).

PURPOSE: To calculate the cost-effectiveness of hepatic arterial chemoembolization (HACE) for the treatment of colorectal liver metastases (CLM) over a range of survival benefits and to determine the survival benefit that HACE must confer to meet three thresholds of cost-effectiveness.

MATERIALS AND METHODS: A spreadsheet model was used to estimate the marginal direct cost of HACE compared with palliative care from a payer’s perspective. Medicare reimbursement amounts represented costs, while probabilities of reembolization and complications were obtained from records of patients who underwent HACE. Marginal cost-effectiveness was calculated from marginal direct cost by varying the survival benefit of HACE compared with palliative care from 0 to 24 months. Break-even analyses were conducted to determine the survival benefit at which the cost-effectiveness of HACE would decrease below three threshold values derived from a literature review.

RESULTS: The marginal cost-effectiveness of HACE compared with palliative care, given survival benefits of 3, 6, and 12 months, was $82,385, $41,193, and $21,045 per life-year (LY) gained, respectively. Cost-effectiveness thresholds of $20,000 (strict), $50,000 (moderate), and $100,000 (generous) per LY gained required survival benefits of 12.63, 4.94, and 2.47 months, respectively, more than the expected baseline.

CONCLUSION: The cost-effectiveness of HACE for the treatment of CLM varies considerably according to the anticipated survival benefit. Results of future randomized controlled trials must demonstrate a survival benefit of nearly 5 months for HACE to meet the moderate cost-effectiveness standard of $50,000 per LY gained.

Index terms: Cost-effectiveness • Hepatic arteries, chemotherapeutic embolization, 952.1264, 953.1266 • Interventional procedures, comparative studies • Interventional procedures, technology, 952.1264, 953.1266 • Liver neoplasms, metastases, 761.3327

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