2022 № 4 Choosing optimal treatment organisation strategy for unresectable liver cancer: case of Moscow region
Introduction: despite quite low morbidity with up to 6 thousand cases per year in Russia, therapy for unresectable liver tumors is based on costly therapy with tyrosine kinase inhibitors or anti-PD‑1L agents thus leading to extremely high costs per life year saved. In the meantime, transaterial radioembolization (TARE)technique is reported to show better outcomes in this patient group compared to conservative treatment and transarterial chemotherapy (TACT). This article researches strategic options for regionwide treatment programs focused on involving TARE in unresectable liver tumors treatment.
Methodology. Epidemiological data provided by national cancer report. Systematic review of literature (not meeting PRISMA criteria) was done for TARE vs. TACT and TARE vs. conservative treatment overall survival. Treatment costs were based on current governmental treatment tariffs for Moscow region. Only direct oncology costs were included without possible complications analysis. The final analysis was done for optimistic, pessimistic and moderate expected numbers of patients eligble for TARE.
Results. Optimal treatment strategy implies maximum allowable rate of TARE with patients concentration in selected hospitals. For Moscow region (population of 7,6 million people) estimated yearly benefit of this strategy is 309,3 RUB (USD3,4 million USD) and 284 life years saved based on moderate prognosis.