Budget Impact of Shifting the Treatment Setting of Unresectable Liver Metastases Associated with Primary Colorectal Cancer Using Y-90 Resin Microspheres from the Outpatient Hospital to the Office-Based Laboratory

David C Sperling,1 Katrine Wallace,2,3 Nanette von Oppen,2 Joshua L Weintraub1 1Department of Radiology, Columbia University Irving Medical Center, New York, NY, USA; 2Sirtex Medical, Woburn, MA, USA; 3School of Public Health, University of Illinois Chicago, Chicago, IL, USACorrespondence: Katrine Wallace, School of Public Health, University of Illinois Chicago, 1601-3 W Taylor Street, MC 923, Chicago, IL, 60612, USA, Tel +1 773 551-5971, Email [email protected]: In the wake of ever-increasing health care costs, solutions are sought to make health care more affordable, such as moving hospital outpatient procedures to office-based laboratory (OBL) settings. A budget impact model was constructed to estimate the health plan cost benefit of moving 50% of yttrium-90 resin microspheres (Y-90) selective internal radiation therapy (SIRT) procedures for unresectable liver metastases associated with primary colorectal cancer (CRC) from a traditional hospital outpatient setting (HOPPS) to an OBL setting.Methods: The eligible population was estimated using an incidence-based approach for a hypothetical health plan with 1 million covered lives. Modeled costs were based on 2024 Medicare reimbursement rates. Three treatment scenarios were considered: 1) base case HOPPS, 2) hybrid (HOPPS/OBL), and 3) OBL settings. Budget impacts were estimated as the differences in annual total cost of treatment after switching 50% of Y-90 SIRTs from HOPPS to the hybrid (HOPPS/OBL) or OBL setting. Per-member-per-month (PMPM) budget impacts were also calculated. Sensitivity analyses were conducted by varying the proportions of patients shifting settings and the treatment setting they were shifting into.Results: Annually, 28 patients were estimated to have metastatic CRC and unresectable liver metastases in a health plan of 1 million members. Average estimated per-patient cost savings would be $8,791 by switching one patient to a hybrid setting and $17,697 for a patient switched to the OBL. Switching 50% of eligible procedures resulted in PMPM cost benefits to the plan of $0.0102 for hybrid setting and $0.0206 for OBL. In sensitivity analyses, annual cost savings for the health plan were affected by both the proportion of patients shifted and the setting they were shifted into.Conclusion: Shifting a percentage of the treatment of unresectable liver metastases with Y-90 SIRT to the OBL setting results in modest cost benefits for US health plans.Plain language summary: • Due to the increasing costs of health care, simple changes that can reduce costs are sought.• In this study, we created an economic model to determine if it would save money for US health insurance payors if half of the treatments for metastatic liver cancer, using a procedure called Y-90 selective internal radiation therapy (SIRT), were done in a doctor’s office instead of an outpatient hospital.• The results showed that moving some of these treatments to the doctor’s office would save money for US health insurance plans.• This finding could help to inform policy decisions to enable or expand payor funding channels for these types of procedures to be performed in doctor’s office settings.Keywords: selective internal radiation therapy, mCRC, cost