Health Outcomes and Resource Consumption Analysis of Radioembolization with Y90 Glass Microspheres (Tare-Y90) Versus Transarterial Chemoembolization with Irinotecan (Debiri) in Patients with Liver Metastases from Colorectal Cancer in Spain

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Purpose: The present study aims to investigate superiority of TARE-Y90 in the treatment of liver metastases from colorectal cancer in comparison to DEBIRI and perform a parallel resource consumption study to demonstrate a possible favorable cost-effectiveness balance. Material and Methods: The number of included subjects in the study was 46 for TARE-Y90 and 56 in the DEBIRI group. Variables of interest in the study were collected for all selected subjects. Time-to-endpoint outcomes (overall survival, time to progression and time to extra-hepatic progression) was calculated by Kaplan-Meier analysis and reported as a median with 95% confidence interval and compared between groups by log-rank testing. Survival analyses were performed using R package “survival” 3.5-7. Values for median time-to-event and 95% confidence intervals were calculated using bootstrapping. Results: The categorization into overall response (OR) and no overall response (NOR) revealed a higher percentage of overall responses in the DEBIRI group (52%) compared to TARE-Y90 (24%). The numerical differences observed in certain response categories did not reach statistical significance, indicating a comparable overall response to treatment between the two cohorts based on the m-RECIST criteria. Median overall survival for the TARE-Y90 cohort is 11.3 (95% CI 10.9 – 18.6) months, and 15.8 (95% CI 14.8 – 22.7) months for the DEBIRI cohort. Log-rank testing shows no statistically significant differences (p = 0.53). Median time to hepatic disease progression for the TARE-Y90 cohort is 3.5 (95% CI 3.4 – 8.1) months, and 3.8 (95% CI 3.7 – 11.1) months for the DEBIRI cohort. Log-rank testing shows no statistically significant differences (p = 0.82). An important result of the resource utilization analysis is that TARE-Y90 patients have 1.33 treatments on average by patient, while DEBIRI patients have 3.16 treatments per patient.DEBIRI patients require more than 2 days in the intensive care unit on average, while it is not necessary for TARE-Y90. TARE-Y90 patients also need less days of hospitalization than those of DEBIRI. The consequence is that the overall use of resources is higher for DEBIRI in comparison to TARE-Y90. Conclusion: TARE-Y90 and DEBIRI treatments for CRC liver metastases contributes valuable insights into their comparative effectiveness, revealing no significant, differences in radiological responses and overall survival. TARE-Y90 showed higher resource utilization, its potential advantages in patient comfort and average resource consumption per patient warrant consideration.

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