Cost-effectiveness of hepatic arterial chemoembolization for colorectal liver metastases refractory to systemic chemotherapy

PURPOSE: To calculate the cost-effectiveness of hepatic arterial chemoembol ization (HACE) for the treatment of colorectal liver metastases (CLM) over a range of survival benefits and to determine the survival benefit that HAC E must confer to meet three thresholds of cost-effectiveness. MATERIALS AND METHODS: A spreadsheet model was used to estimate the margina l direct cost of HACE compared with palliative care from a payer's perspect ive. 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 margina l direct cost by varying the survival benefit of HACE compared with palliat ive care from 0 to 24 months. Break-even analyses were conducted to determi ne the survival benefit at which the cost-effectiveness of HACE would decre ase below three threshold values derived from a literature review. RESULTS: The marginal cost-effectiveness of HACE compared with palliative c are, 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 thr esholds of $20,000 (strict), $50,000 (moderate), and $100,000 (generous) pe r LY gained required survival benefits of 12.63, 4.94, and 2.47 months, res pectively, 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 futu re randomized controlled trials must demonstrate a survival benefit of near ly 5 months for HACE to meet the moderate cost-effectiveness standard of $5 0,000 per LY gained.