Part 1: Imaging findings of common immune checkpoint inhibitor-related adverse effects

A study comparing the cost-effectiveness of conventional and drug-eluting transarterial chemoembolisation (cTACE and DEB-TACE) for the treatment of hepatocellular carcinoma in an Australian public hospital

INTRODUCTION

Hepatocellular carcinoma (HCC) is a leading cause of cancer-related mortality and transarterial chemoembolisation (TACE) is an established technique to treat patients with intermediate-stage HCC. The aim of this study was to generate accurate costing data on cTACE and DEB-TACE in an Australian setting and assess whether one of the procedures offers favourable cost-effectiveness.

METHODS

Costing study using data from all TACE procedures performed at a single centre between January 2018 and December 2022. Data were included from all direct and indirect costs including operative costs, wages, overheads, ward costs, transfusion, pathology, pharmacy and ward support. Cost-effectiveness was assessed by dividing local costs by existing high-quality data on quality-adjusted life years (QALYs).

RESULTS

64 TACE treatments were performed on 44 patients. Mean age was 66.5 years and 91% were male. Overall median total cost per patient for the entire TACE treatment regime was AUD$7380 (range AUD$3719-$20,258). However, 39% of patients received more than one treatment, and the median cost per individual treatment was AUD$5270 (range AUD$3533-$15,818). The difference in median cost between cTACE (AUD$4978) and DEB-TACE (AUD$9202) was significant, P < 0.001. In calculating cost-effectiveness, each cTACE treatment cost AUD$2489 per QALY gained, while each DEB-TACE cost AUD$3834 per QALY gained. The incremental cost-effectiveness ratio (ICER) for DEB-TACE over cTACE was AUD$10,560 per QALY gained.

CONCLUSION

Both cTACE and DEB-TACE are low-cost treatments in Australia. However, DEB-TACE offers a solution with an ICER of AUD$10,560 per QALY gained which is below the Australian government willingness to pay threshold and thus is a more cost-effective treatment.

Immunotherapy, radiation oncology and radiology: An alliance into the future

AUTHOR BIOGRAPHIES

A/Prof Eric Hau is a clinician-scientist with interest in lung and CNS tumours. His clinical and laboratory research focuses on understanding the mechanisms of radiation resistance and investigating drugs which may be utilised for radiation sensitisation to improve outcomes for patients. Associate Professor Warren Clements is an Interventional Radiologist at Alfred Health and has an Adjunct appointment with the Department of Surgery, Central Clinical School, Monash University. A/Prof Clements completed post-fellowship subspecialty training in Interventional Radiology, consolidated by completion of the EBIR certification. A/Prof Clements is actively involved in medical research with over 80 peer-reviewed publications, and has presented his research at national and international conferences. He is an Associate Editor for JMIRO and editorial board member of both CVIR and CVIR Endovascular. He volunteers his time for RANZCR as a member of the Interventional Radiology Committee and as an editorial board member for RANZCR's Inside Radiology website. A/Prof Clements has a keen interest in education and training, and is the supervisor of Intern Training in the Radiology Department. Dr. Joseph (Joe) Sia is a Consultant Radiation Oncologist at the Peter MacCallum Cancer Centre, Melbourne, Australia. He obtained his medical degree from the University of Otago, New Zealand and completed his radiation oncology training in Melbourne in 2017. He then undertook a laboratory-based PhD in tumour immunology at the University of Melbourne, which was awarded in 2020.