Title: ECONOMIC EVALUATIONS OF RADIOEMBOLIZATION WITH ITRIUM-90
MICROSPHERES IN HEPATOCELLULAR CARCINOMA: A SYSTEMATIC REVIEW
Version: 1 Date: 26 May 2022
Reviewer's report:
In this study, the authors aimed to perform a systematic review of the available economic
evaluations of Transarterial radioembolization (TARE) with yttrium-90 microspheres for the
treatment of HCC.
All studies identified as economic evaluations with TARE for HCC treatment in English or
Spanish language were considered.
They selected 20 studies  and assessed populations included early- (n=4), and intermediate-
advanced-stages patients (n=15).
TARE was compared with transarterial chemoembolization (TACE) (n=9) or sorafenib (n=11).
Life-years gained for TARE ranged from 1.3 to 3.1 vs. TACE and from 1.1 to 2.53 for TARE
vs. sorafenib. TARE was associated with lower treatment cost in ten studies. TARE cost varied
widely according to Barcelona Clinic Liver Cancer (BCLC) staging system .
They concluded that economic evaluations of TARE for HCC treatment are heterogeneous. and
that TARE is a cost-effective short- and long-term therapy for the treatment of intermediate-
advanced HCC.
The study is of interest and the topic of current major clinical relevance. However, some points
deserve further data and should be addressed.
In my opinion, the authors should further discuss the comparison between TARE and systemic
treatment. They have only considered sorafenib, however, new systemic agents were developed
and approved after 2015.  In their conclusion, they should recall how the systemic treatment
of HCC is improved in the last 5 years. In particular, they should discuss the availability
of sequential systemic treatments after sorafenib failure, with second-line regorafenib and
third-line cabozantinib, as recently described (Experience with regorafenib in the treatment of
hepatocellular carcinoma. Therap Adv Gastroenterol. 2021 May 28;14:17562848211016959;
Real-Life Clinical Data of Cabozantinib for Unresectable Hepatocellular Carcinoma. Liver
Cancer. 2021 Jul;10(4):370-379.).
Moreover, they should also discuss that TARE may be associated with liver function
deterioration (from Child-Pugh class A to Child-Pugh class B) potentially precluding the
feasibility of systemic therapy that can be administered only to patients with preserved liver
function (Non-transplant therapies for patients with hepatocellular carcinoma and Child-Pugh-
Turcotte class B cirrhosis. Lancet Oncol. 2017 Feb;18(2):e101-e112.).
Title: ECONOMIC EVALUATIONS OF RADIOEMBOLIZATION WITH ITRIUM-90
MICROSPHERES IN HEPATOCELLULAR CARCINOMA: A SYSTEMATIC REVIEW
Version: 1 Date: 26 May 2022
Reviewer's report:
In this study, the authors aimed to perform a systematic review of the available economic
evaluations of Transarterial radioembolization (TARE) with yttrium-90 microspheres for the
treatment of HCC.
All studies identified as economic evaluations with TARE for HCC treatment in English or
Spanish language were considered.
They selected 20 studies  and assessed populations included early- (n=4), and intermediate-
advanced-stages patients (n=15).
TARE was compared with transarterial chemoembolization (TACE) (n=9) or sorafenib (n=11).
Life-years gained for TARE ranged from 1.3 to 3.1 vs. TACE and from 1.1 to 2.53 for TARE
vs. sorafenib. TARE was associated with lower treatment cost in ten studies. TARE cost varied
widely according to Barcelona Clinic Liver Cancer (BCLC) staging system .
They concluded that economic evaluations of TARE for HCC treatment are heterogeneous. and
that TARE is a cost-effective short- and long-term therapy for the treatment of intermediate-
advanced HCC.
The study is of interest and the topic of current major clinical relevance. However, some points
deserve further data and should be addressed.
In my opinion, the authors should further discuss the comparison between TARE and systemic
treatment. They have only considered sorafenib, however, new systemic agents were developed
and approved after 2015.  In their conclusion, they should recall how the systemic treatment
of HCC is improved in the last 5 years. In particular, they should discuss the availability
of sequential systemic treatments after sorafenib failure, with second-line regorafenib and
third-line cabozantinib, as recently described (Experience with regorafenib in the treatment of
hepatocellular carcinoma. Therap Adv Gastroenterol. 2021 May 28;14:17562848211016959;
Real-Life Clinical Data of Cabozantinib for Unresectable Hepatocellular Carcinoma. Liver
Cancer. 2021 Jul;10(4):370-379.).
Moreover, they should also discuss that TARE may be associated with liver function
deterioration (from Child-Pugh class A to Child-Pugh class B) potentially precluding the
feasibility of systemic therapy that can be administered only to patients with preserved liver
function (Non-transplant therapies for patients with hepatocellular carcinoma and Child-Pugh-
Turcotte class B cirrhosis. Lancet Oncol. 2017 Feb;18(2):e101-e112.).
Please review this paper.
user
Title: ECONOMIC EVALUATIONS OF RADIOEMBOLIZATION WITH ITRIUM-90
MICROSPHERES IN HEPATOCELLULAR CARCINOMA: A SYSTEMATIC REVIEW
Version: 1 Date: 26 May 2022
Reviewer's report:
In this study, the authors aimed to perform a systematic review of the available economic
evaluations of Transarterial radioembolization (TARE) with yttrium-90 microspheres for the
treatment of HCC.
All studies identified as economic evaluations with TARE for HCC treatment in English or
Spanish language were considered.
They selected 20 studies  and assessed populations included early- (n=4), and intermediate-
advanced-stages patients (n=15).
TARE was compared with transarterial chemoembolization (TACE) (n=9) or sorafenib (n=11).
Life-years gained for TARE ranged from 1.3 to 3.1 vs. TACE and from 1.1 to 2.53 for TARE
vs. sorafenib. TARE was associated with lower treatment cost in ten studies. TARE cost varied
widely according to Barcelona Clinic Liver Cancer (BCLC) staging system .
They concluded that economic evaluations of TARE for HCC treatment are heterogeneous. and
that TARE is a cost-effective short- and long-term therapy for the treatment of intermediate-
advanced HCC.
The study is of interest and the topic of current major clinical relevance. However, some points
deserve further data and should be addressed.
In my opinion, the authors should further discuss the comparison between TARE and systemic
treatment. They have only considered sorafenib, however, new systemic agents were developed
and approved after 2015.  In their conclusion, they should recall how the systemic treatment
of HCC is improved in the last 5 years. In particular, they should discuss the availability
of sequential systemic treatments after sorafenib failure, with second-line regorafenib and
third-line cabozantinib, as recently described (Experience with regorafenib in the treatment of
hepatocellular carcinoma. Therap Adv Gastroenterol. 2021 May 28;14:17562848211016959;
Real-Life Clinical Data of Cabozantinib for Unresectable Hepatocellular Carcinoma. Liver
Cancer. 2021 Jul;10(4):370-379.).
Moreover, they should also discuss that TARE may be associated with liver function
deterioration (from Child-Pugh class A to Child-Pugh class B) potentially precluding the
feasibility of systemic therapy that can be administered only to patients with preserved liver
function (Non-transplant therapies for patients with hepatocellular carcinoma and Child-Pugh-
Turcotte class B cirrhosis. Lancet Oncol. 2017 Feb;18(2):e101-e112.).
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