Cost–Benefit Analysis of Trans-Arterial Radio-Embolization with Y-90 Glass Microspheres Versus Drug-Eluting Bead Trans-Arterial Chemo-Embolization in Patients with Hepatocellular Carcinoma in Italy

Abstract Purpose To evaluate the cost–benefit of Trans-Arterial Radio-Embolization (TARE) with Y-90 glass microspheres compared to Drug-Eluting Bead Trans-Arterial Chemo-Embolization (DEB-TACE) in patients with intermediate- and early-stage hepatocellular carcinoma (HCC) not eligible for surgery or ablation. Materials and Methods A partitioned survival model estimated life years (LYs) and costs over a 2-year horizon, considering the complete initial care pathway. The analysis was conducted in two scenarios, TARE with standard (SD) or personalized dosimetry (PD). Clinical data were sourced and adapted from the TRACE study, and real-world resource utilization and costs were collected from five high-volume Italian oncology centers. A micro-costing approach assessed value for money from the hospital perspective, expressed as Incremental Net Monetary Benefit (INMB), applying a willingness-to-pay (WTP) threshold of 50,000€/LY. Results TARE showed greater survival (SD: 1.617 LYs, PD: 1.823 LYs vs 1.331 LYs DEB-TACE) and higher overall costs (SD: 32,381€, PD: 32,922€ vs 27,735€ DEB-TACE) at 2 years, reflecting its greater healthcare utilization driven by better outcomes. TARE was associated with a positive INMB (SD: 9,664€; PD: 19,429€), demonstrating cost-effectiveness. Conclusion Due to improved survival and a positive INMB under both standard and personalized dosimetry, TARE is more cost-effective than DEB-TACE, showing greater value for money compared to DEB-TACE. These results aim to support informed decision-making on the treatment options for patients with unresectable HCC. Graphical Abstract