# 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

## TL;DR

This study compares the cost-effectiveness of two treatments for liver cancer in Italy, finding that one provides better survival and value for money.

## Contribution

The study introduces a cost–benefit analysis of TARE with Y-90 microspheres versus DEB-TACE for hepatocellular carcinoma using real-world data from Italian centers.

## Key findings

- TARE with standard and personalized dosimetry showed greater survival than DEB-TACE.
- TARE had higher costs but demonstrated a positive incremental net monetary benefit.
- Results support TARE as a more cost-effective treatment option for unresectable hepatocellular carcinoma.

## Abstract

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.

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.

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.

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.

The online version contains supplementary material available at 10.1007/s00270-025-04214-4.