ABSTRACT
WHAT IS KNOWN AND OBJECTIVE: Drug eluting beads (DEBs) theoretically improve the efficacy and safety of transarterial chemoembolization (TACE) in hepatocellular carcinoma (HCC). Nonetheless, their economic profile has not been assessed. Our retrospective before/after study aimed to compare efficacy, safety and economic profile of two strategies of TACE without (Period 1) or with the possibility of using DEBs (Period 2). METHODS: All HCC patients treated by TACE in our hospital between March 2006 and May 2013 were included. Economic analyses were performed from the French Public Health Insurance point of view according to the French Diagnosis-Related Group prospective payment system and from the analytic accountability. RESULTS AND DISCUSSION: One hundred and sixty-one patients were included. Median time to treatment failure and overall survival were 13.1 and 23.8 months in Period 1 vs. 14.1 and 30.2 months in Period 2 (P = 0.45 and P = 0.40). Mean hospital durations and tariffs were 14.9 ± 7.7 days and 11 472 ± 5901 in Period 1 vs. 12.4 ± 8.4 days and 7654 ± 4625 in Period 2 (P = 0.03 and P < 10(-4) ). WHAT IS NEW AND CONCLUSION: The possibility of using DEBs did not improve the prognosis in HCC patients treated by TACE. Nonetheless, it had a better medico-economic profile.
Subject(s)
Antineoplastic Agents/administration & dosage , Carcinoma, Hepatocellular/therapy , Chemoembolization, Therapeutic/economics , Chemoembolization, Therapeutic/methods , Drug Carriers/administration & dosage , Drug Carriers/economics , Liver Neoplasms/therapy , Adult , Aged , Aged, 80 and over , Antineoplastic Agents/economics , Carcinoma, Hepatocellular/economics , Carcinoma, Hepatocellular/mortality , Cost-Benefit Analysis/economics , Cost-Benefit Analysis/methods , Doxorubicin/administration & dosage , Drug Costs , Ethiodized Oil/administration & dosage , Ethiodized Oil/economics , Female , Humans , Idarubicin/administration & dosage , Idarubicin/economics , Liver Neoplasms/economics , Liver Neoplasms/mortality , Male , Microspheres , Middle Aged , Prognosis , Retrospective Studies , Survival Rate , Treatment OutcomeABSTRACT
PURPOSE: The aim of our study was to assess the results and cost of a treatment strategy involving transarterial chemoembolisation with drug eluting beads (DEB-TACE) in patients with unresectable non-metastatic hepatocellular carcinoma (HCC). PATIENTS AND METHODS: This study included all patients treated with DEB-TACE in our hospital between January 2009 and December 2010. All patients received DEB-TACE on demand and were evaluated after each session. RESULTS: Twenty-one patients received an average of 1.3 sessions. The median time to treatment discontinuation and median progression-free survival was 181 days and 295 days, respectively. Toxicity caused treatment discontinuation in three patients (14%). For the hospital, the average direct cost of treatment was 6,033 according to the analytical accounting system vs. 4,558 according to the official tariffs from the new French Diagnosis-Related Group prospective payment system (P=0.002). CONCLUSION: In the treatment of HCC, on-demand DEB-TACE stabilises the disease in some patients but has not yet been thoroughly evaluated.
