On March 31, 2021, NICE published Technology Appraisal Guidance on selective internal radiation therapies (SIRT) for treating hepatocellular carcinoma (HCC).
Technology Appraisal is the only NICE program that has a direct link with the acceptance of technologies by payers. Payers need to implement the recommended technologies within three months after the publication of the guidance. Medical devices are very rarely evaluated within the Technology Appraisal program.
SIRTs are small radioactive beads that are injected into the liver's blood supply to treat liver cancer. The appraisal considered SIR-Spheres, TheraSphere, and QuiremSpheres.
NICE provided the following recommendations:
- The SIRT SIR-Spheres and TheraSphere are recommended as an option for treating unresectable advanced HCC in adults, only if used for people with Child-Pugh grade A liver impairment when conventional transarterial therapies are inappropriate, and the companies provide SIR-Spheres or TheraSphere according to the commercial arrangements;
- The SIRT QuiremSpheres is not recommended for treating unresectable advanced HCC in adults.
These recommendations are not intended to affect treatment with SIR-Spheres, TheraSphere, and QuiremSpheres started in the NHS before this guidance was published. People having treatment outside these recommendations may continue without change to the funding arrangements in place before this guidance was published until they and their NHS clinician consider it appropriate to stop.
NICE recommendations are based on the following considerations:
- The clinical trial data for three SIRTs under the scope compared with other treatment options are limited. But, compared with sorafenib, SIRTs may have fewer and more manageable adverse effects, which can improve quality of life;
- There is not enough evidence to consider SIRTs a cost-effective use of NHS resources for people with early and intermediate HCC;
- For people with advanced HCC, QuiremSpheres is less clinically effective than sorafenib and costs more, so it is not recommended;
- SIR-Spheres and TheraSphere are slightly less clinically effective than sorafenib but cost less.
See the full details here.
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