PMID- 19877181
OWN - NLM
STAT- MEDLINE
DCOM- 20100115
LR  - 20181201
IS  - 1527-3350 (Electronic)
IS  - 0270-9139 (Linking)
VI  - 51
IP  - 1
DP  - 2010 Jan
TI  - Use of sorafenib in patients with hepatocellular carcinoma before liver 
      transplantation: a cost-benefit analysis while awaiting data on sorafenib safety.
PG  - 165-73
LID - 10.1002/hep.23260 [doi]
AB  - The role of bridging therapies for patients with hepatocellular carcinoma (HCC) 
      on the waiting list for liver transplantation (LT) remains controversial. There 
      is strong evidence to support the effectiveness of sorafenib in extending the 
      time to progression of HCC. Using a Markov model, we compared two strategies: one 
      using sorafenib as neoadjuvant therapy before LT (Strategy A), and the other 
      using no bridging therapy in the first 6 months (Strategy B). Reference case: T2 
      HCC patient with compensated cirrhosis. The benefit of sorafenib in delaying time 
      to HCC progression was expressed as the hazard ratio (HR) and taken from recently 
      published randomized trials. The endpoints considered were: survival benefit 
      measured in quality-adjusted life days (QALDs), transplant probability, costs (C) 
      in euro, willingness to pay (WTP), and net health benefit (NHB), where NHB = 
      survival benefit - C/WTP. The calculated WTP of sorafenib in Italy was 346 euro 
      per QALD. Probabilistic sensitivity analysis showed a median survival benefit of 
      94 QALDs (10% percentile = 38, 90% percentile = 210). In the base-case scenario 
      (HR = 0.47, monthly dropout probability = 5%, median time to LT = 3 months), the 
      gain in LT probability due to sorafenib was 5% and it increased proportionally 
      with increasing median times to LT and decreasing HR. In the cost-benefit 
      analysis, the incremental NHB of Strategy A versus Strategy B was 37 QALDs; it 
      increased as sorafenib HR decreased and when median times to LT were shorter than 
      6 months, whereas for longer times it gradually dropped, particularly when 
      Strategy B included effective locoregional treatments. CONCLUSION: Sorafenib 
      neoadjuvant therapy is cost-effective by comparison with no therapy for T2-HCC 
      patients waiting for LT, particularly for median times to LT under 6 months.
FAU - Vitale, Alessandro
AU  - Vitale A
AD  - Unita di Chirurgia Oncologica, Istituto Oncologico Veneto, IRCCS, Padova, Italy. 
      alessandro.vitale@unipd.it
FAU - Volk, Michael L
AU  - Volk ML
FAU - Pastorelli, Davide
AU  - Pastorelli D
FAU - Lonardi, Sara
AU  - Lonardi S
FAU - Farinati, Fabio
AU  - Farinati F
FAU - Burra, Patrizia
AU  - Burra P
FAU - Angeli, Paolo
AU  - Angeli P
FAU - Cillo, Umberto
AU  - Cillo U
LA  - eng
PT  - Journal Article
PL  - United States
TA  - Hepatology
JT  - Hepatology (Baltimore, Md.)
JID - 8302946
RN  - 0 (Antineoplastic Agents)
RN  - 0 (Benzenesulfonates)
RN  - 0 (Phenylurea Compounds)
RN  - 0 (Pyridines)
RN  - 25X51I8RD4 (Niacinamide)
RN  - 9ZOQ3TZI87 (Sorafenib)
SB  - IM
CIN - Hepatology. 2010 Jan;51(1):12-5. PMID: 20034046
CIN - Hepatology. 2010 Jun;51(6):2232-3. PMID: 20041410
CIN - Hepatology. 2010 Sep;52(3):1171-2. PMID: 20812364
CIN - J Hepatol. 2012 Mar;56(3):723-5. PMID: 22127280
MH  - Antineoplastic Agents/*therapeutic use
MH  - Benzenesulfonates/*therapeutic use/toxicity
MH  - Carcinoma, Hepatocellular/drug therapy/economics/*therapy
MH  - Cost-Benefit Analysis
MH  - Humans
MH  - Liver Transplantation
MH  - Markov Chains
MH  - Models, Theoretical
MH  - Monte Carlo Method
MH  - Niacinamide/analogs & derivatives
MH  - Phenylurea Compounds
MH  - Pyridines/*therapeutic use/toxicity
MH  - Quality-Adjusted Life Years
MH  - Sorafenib
MH  - Treatment Outcome
MH  - Waiting Lists
EDAT- 2009/10/31 06:00
MHDA- 2010/01/16 06:00
CRDT- 2009/10/31 06:00
PHST- 2009/10/31 06:00 [entrez]
PHST- 2009/10/31 06:00 [pubmed]
PHST- 2010/01/16 06:00 [medline]
AID - 10.1002/hep.23260 [doi]
PST - ppublish
SO  - Hepatology. 2010 Jan;51(1):165-73. doi: 10.1002/hep.23260.