In:
Journal of Clinical Oncology, American Society of Clinical Oncology (ASCO), Vol. 30, No. 15_suppl ( 2012-05-20), p. e14522-e14522
Abstract:
e14522 Background: Multiple treatment options for HCC exist and the treatment(s) received depend on clinical characteristics, resource availability and access to specialists. Their comparative cost effectiveness is unclear. Methods: Medicare patients with a 1st diagnosis of 1ry HCC in 2000-07 were studied through end of ‘09. Data are from the SEER with linked Medicare parts A-B. We use incremental cost effectiveness ratios (ICERs) and 95% cost intervals for transarterial chemoembolization (TACE) vs no treatment, liver transplantation (OLT), surgical resection (RS), radiofrequency ablation (AB), systemic chemotherapy (CH), and radiation therapy (RD). Using HCC-related mortality, Cox proportional hazards models were used to compute mean life years survived (LY) under each modality, adjusting for clinical (cancer stage, underlying health status, liver conditions) and demographics. Multiple propensity scores were incorporated to adjust for treatment selection bias. Average HCC-related Medicare costs (US$2011) attributed to each modality are estimated using generalized least squares methods. Results: Cancer stages 1, 2, 3, and 4 represent 24%, 9%, 14%, and 17% of the 11,047 patients: 37% unstaged, 66% male, 75% Caucasian, 10% African American, and 13% Hispanic, 61% of patients untreated, 8% TACE, 2% “liver directed therapy” (LD), 4% OLT, 8% RS, 5% AB, 8% CH, and 6% RDST. Relative to no treatment, OLT was most effective in reducing HCC mortality (HR .06, p 〈 .01), followed by RS (HR .19, p 〈 .01), LD (HR .25, p 〈 .01), AB (HR .33, p 〈 .01), TACE (HR .39, p 〈 .01), RD (HR .44, p 〈 .01), CH (HR .49, p 〈 .01). All ICERs were significant; OLT cost effective ($2,951/LY), followed by RS ($5,801/LY), RD ($6,322/LY), CH ($6,748/LY), AB ($8,405/LY), TACE ($9,074/LY), then LD ($10,453/LY). Conclusions: In SEER-Medicare patients, all treatments were associated with reduction in HCC-related mortality. TACE was more effective when combined with ablative therapy, yet OLT and resection were still more effective. Though, OLT patients are more likely than others to survive. TACE alone was only more effective than radiation therapy and systemic chemotherapy.
Type of Medium:
Online Resource
ISSN:
0732-183X
,
1527-7755
DOI:
10.1200/jco.2012.30.15_suppl.e14522
Language:
English
Publisher:
American Society of Clinical Oncology (ASCO)
Publication Date:
2012
detail.hit.zdb_id:
2005181-5
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